Provider Demographics
NPI:1669640983
Name:MAUDAL, GAIL ROSE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ROSE
Last Name:MAUDAL
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 EDGERTON ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1620
Mailing Address - Country:US
Mailing Address - Phone:651-484-1544
Mailing Address - Fax:651-415-1337
Practice Address - Street 1:325 E MAIN ST
Practice Address - Street 2:ANOKA COURTHOUSE
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2401
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1096103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist