Provider Demographics
NPI:1184756801
Name:JOEL, GAY LUANNE (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:GAY
Middle Name:LUANNE
Last Name:JOEL
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
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Mailing Address - Street 1:2247 CLEVELAND ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4018
Mailing Address - Country:US
Mailing Address - Phone:612-787-0658
Mailing Address - Fax:
Practice Address - Street 1:3137 HENNEPIN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2601
Practice Address - Country:US
Practice Address - Phone:612-702-6078
Practice Address - Fax:612-273-9110
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP4280103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680001553Medicare ID - Type UnspecifiedPSYCHOLOGIST