Provider Demographics
NPI:1508242223
Name:GILDNER, ALLISON C
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:C
Last Name:GILDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:C
Other - Last Name:SEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18510 STATE HWY 371
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-6825
Mailing Address - Country:US
Mailing Address - Phone:218-772-3353
Mailing Address - Fax:218-514-4154
Practice Address - Street 1:13045 FALCON DR STE 100
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-4201
Practice Address - Country:US
Practice Address - Phone:218-829-9307
Practice Address - Fax:218-829-7649
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1736101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional