Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP3228 | MN |
NPI | 1114925468 |
---|---|
Provider Name | John M Gessner |
First Address | Burnsville, MN 55337-5507 |
Second Address | Burnsville, MN 55337-5507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 30/12/2011 |