Provider Demographics
NPI:1053670059
Name:GATZKE, ADAM LEE
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:LEE
Last Name:GATZKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NATHAN LN N APT 351
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6490
Mailing Address - Country:US
Mailing Address - Phone:952-412-5909
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD STE 160
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1367
Practice Address - Country:US
Practice Address - Phone:763-566-0088
Practice Address - Fax:763-566-0089
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health