Provider Demographics
NPI:1225776586
Name:GIDLUND, JEAN (MA)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:GIDLUND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAY O VAC DR STE 320
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2471
Mailing Address - Country:US
Mailing Address - Phone:608-520-0846
Mailing Address - Fax:
Practice Address - Street 1:700 RAY O VAC DR STE 320
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2471
Practice Address - Country:US
Practice Address - Phone:608-520-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist