Provider Demographics
NPI:1043317837
Name:HARTMAN, GAIL DELWYN (LP, MA)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:DELWYN
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 VINCENT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1141
Mailing Address - Country:US
Mailing Address - Phone:612-928-0074
Mailing Address - Fax:
Practice Address - Street 1:1409 WILLOW ST
Practice Address - Street 2:SUITE 501
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2269
Practice Address - Country:US
Practice Address - Phone:612-871-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1781103T00000X
MN13181041C0700X
MN0143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist