Provider Demographics
NPI:1710163175
Name:SEMMLER, GERALD T (PHD, LP)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:T
Last Name:SEMMLER
Suffix:
Gender:M
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 1:2502 LYNDALE AVE S
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-3319
Mailing Address - Country:US
Mailing Address - Phone:612-871-9215
Mailing Address - Fax:
Practice Address - Street 1:2502 LYNDALE AVE S
Practice Address - Street 2:APARTMENT A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-3319
Practice Address - Country:US
Practice Address - Phone:612-871-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical