Provider Demographics
NPI:1740520592
Name:GJESTSON, ANNE MARIE (MS)
Entity type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:
Last Name:GJESTSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 NETHERBY PL
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1100
Mailing Address - Country:US
Mailing Address - Phone:925-212-1374
Mailing Address - Fax:
Practice Address - Street 1:249 NETHERBY PL
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1100
Practice Address - Country:US
Practice Address - Phone:925-212-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMASTERS OF SCIENCE103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst