Gwen Brutlag, M.S., L.P.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP 1204 Issued in MN

Practice address

220 W Washington Ave
Wells Fargo Bank Building, Suite 204
Fergus Falls, MN 56537-2569

Phone

(218) 739-8761

Fax

(218) 739-8581

NPI assigned

Apr 10, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275656431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 W WASHINGTON AVE",
            "address_2": "WELLS FARGO BANK BUILDING, SUITE 204",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372569",
            "telephone_number": "218-739-8761",
            "fax_number": "218-739-8581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W WASHINGTON AVE",
            "address_2": "WELLS FARGO BANK BUILDING, SUITE 204",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372569",
            "telephone_number": "218-739-8761",
            "fax_number": "218-739-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUTLAG",
        "first_name": "GWEN",
        "credential": "M.S., L.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP 1204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED ID NUMBER",
            "identifier": "1991028",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISENCE NUMBER",
            "identifier": "LP 1204",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Jo Bronson, M OTR-L
• Brittani Joy Brown
• Deborah Mary Brown, LPN
• Kelly Jo Brown, LPN
• Shaylee Brown
• Alyce Marie Bryniarski
• Trent Landel Bullerman, RN
• Ashley Nicole Burns, PA-C
• Cynthia Kay Burton, LPN PCA
• Kristin Bye, RN, PHN, BSN

• Psychologist in Fergus Falls, MN
• Providers in Fergus Falls, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.