Provider Demographics
NPI:1598953598
Name:GURGANUS, SARA LEA (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:LEA
Last Name:GURGANUS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7241 OHMS LN
Mailing Address - Street 2:SUITE 145
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2136
Mailing Address - Country:US
Mailing Address - Phone:952-920-0711
Mailing Address - Fax:952-920-0716
Practice Address - Street 1:7241 OHMS LN
Practice Address - Street 2:SUITE 145
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2136
Practice Address - Country:US
Practice Address - Phone:952-920-0711
Practice Address - Fax:952-920-0716
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP4536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680002051Medicare PIN