Provider Demographics
NPI:1215001136
Name:GILBERTSON, THERESE KOHS (MA, LP)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:KOHS
Last Name:GILBERTSON
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 1:4175 NANCY PL
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-6411
Mailing Address - Country:US
Mailing Address - Phone:651-415-0900
Mailing Address - Fax:651-275-8723
Practice Address - Street 1:2150 RADIO DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9453
Practice Address - Country:US
Practice Address - Phone:651-275-8714
Practice Address - Fax:541-275-8723
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0422103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist