Individual
MS. MARY BETH GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1845 E LAKE ST, MINNEAPOLIS, MN 55407-1859
(612) 721-6215
(612) 721-5848
Mailing address
1845 E LAKE ST, MINNEAPOLIS, MN 55407-1859
(612) 721-6215
(612) 721-5848
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
15931
MN
Other
Enumeration date
02/08/2010
Last updated
02/08/2010
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