Provider Demographics
NPI:1043228109
Name:SEIVERT, GREGORY NORBERT (MS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:NORBERT
Last Name:SEIVERT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MAIN ST SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2124
Mailing Address - Country:US
Mailing Address - Phone:612-379-2640
Mailing Address - Fax:612-379-2820
Practice Address - Street 1:219 MAIN ST SE
Practice Address - Street 2:SUITE 400
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2124
Practice Address - Country:US
Practice Address - Phone:612-379-2640
Practice Address - Fax:612-379-2820
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0646103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist