Provider Demographics
NPI:1225256316
Name:GUNVALSON, JEANNE L (MS, CCC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:GUNVALSON
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SEQUOIA RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3400
Mailing Address - Country:US
Mailing Address - Phone:763-350-6693
Mailing Address - Fax:
Practice Address - Street 1:3490 LEXINGTON AVE N
Practice Address - Street 2:SUITE 305
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8074
Practice Address - Country:US
Practice Address - Phone:651-639-0942
Practice Address - Fax:651-639-1718
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist