Provider Demographics
NPI:1063631695
Name:THOEN, GAIL ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ANN
Last Name:THOEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12525-42 AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1265
Mailing Address - Country:US
Mailing Address - Phone:763-551-1518
Mailing Address - Fax:
Practice Address - Street 1:12525 42 AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1265
Practice Address - Country:US
Practice Address - Phone:763-551-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0672103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist