Provider Demographics
NPI:1285690115
Name:GLUEK, MAUREEN E (PSYD-LP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:GLUEK
Suffix:
Gender:F
Credentials:PSYD-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 W 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3007
Mailing Address - Country:US
Mailing Address - Phone:651-241-1000
Mailing Address - Fax:
Practice Address - Street 1:1026 W 7TH STREET
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3007
Practice Address - Country:US
Practice Address - Phone:651-241-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1872103T00000X
MN06386104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
680001757Medicare ID - Type Unspecified
OTH000Medicare UPIN