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Individual

RICHARD LEE GERTSEMA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-1186
(218) 722-0373
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-1186
(218) 722-0373

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1766
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1891727277
MN
01
34Q94GE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
07/07/2006
Last updated
01/11/2012
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