Provider Demographics
NPI:1649411406
Name:GUNLICKS-STOESSEL, MEREDITH L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:L
Last Name:GUNLICKS-STOESSEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MEREDITH
Other - Middle Name:L
Other - Last Name:GUNLICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:F256/2B WEST, DEPARTMENT OF PSYCHIATRY
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1495
Mailing Address - Country:US
Mailing Address - Phone:612-273-9844
Mailing Address - Fax:612-273-9779
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:F256/2B WEST, DEPARTMENT OF PSYCHIATRY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-9844
Practice Address - Fax:612-273-9779
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNGL0009103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical