Provider Demographics
NPI:1811059959
Name:LUDWIG, NANCY GAIL (MA, LP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:GAIL
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6090 117TH ST N
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5725
Mailing Address - Country:US
Mailing Address - Phone:651-402-4145
Mailing Address - Fax:
Practice Address - Street 1:3570 LEXINGTON AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8049
Practice Address - Country:US
Practice Address - Phone:651-481-0664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN15F49LUOtherBCBS OF MN
MNHP26421OtherHEALTH PARTNERS