Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP3160 | MN |
NPI | 1073506846 |
---|---|
Provider Name | Dr. Gary D Vikesland |
First Address | Golden Valley, MN 55427-4562 |
Second Address | Golden Valley, MN 55427-4562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 25/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
069523800 | (05) | MN |