Provider Demographics
NPI:1114024817
Name:ANDERSON, GAIL OLINE (MA,LP)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:OLINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10410 KAHLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8184
Mailing Address - Country:US
Mailing Address - Phone:763-295-5426
Mailing Address - Fax:763-295-5426
Practice Address - Street 1:22 WILSON AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-0440
Practice Address - Country:US
Practice Address - Phone:320-251-7700
Practice Address - Fax:320-251-8898
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health