Provider Demographics
NPI:1376258475
Name:HAISMAN, GRETCHEN ANNE (MA, LAMFT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANNE
Last Name:HAISMAN
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4877 BULRUSH BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-5812
Mailing Address - Country:US
Mailing Address - Phone:952-465-5434
Mailing Address - Fax:
Practice Address - Street 1:8401 WAYZATA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1377
Practice Address - Country:US
Practice Address - Phone:763-544-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist