Provider Demographics
NPI:1396422739
Name:PEARSON, GILLIAN (LADC)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14949 62ND ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6102
Mailing Address - Country:US
Mailing Address - Phone:651-430-7930
Mailing Address - Fax:
Practice Address - Street 1:14949 62ND ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6102
Practice Address - Country:US
Practice Address - Phone:651-430-7930
Practice Address - Fax:651-430-6527
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)