Provider Demographics
NPI:1114925468
Name:GESSNER, JOHN M (MALP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:GESSNER
Suffix:
Gender:M
Credentials:MALP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 JUDICIAL RD
Mailing Address - Street 2:S 210
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5507
Mailing Address - Country:US
Mailing Address - Phone:952-224-2990
Mailing Address - Fax:952-224-2990
Practice Address - Street 1:2960 JUDICIAL RD
Practice Address - Street 2:S 210
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5507
Practice Address - Country:US
Practice Address - Phone:952-224-2990
Practice Address - Fax:952-224-2990
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3228103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling