Active NPI
Gary Edward Hertog, PSY.D.
- Clinical Psychologist
- Red Wing, MN
National Provider Identifier
1710074208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3783
- Practice address
- 426 West Ave
Red Wing, MN 55066-2473 - Phone
- (651) 385-6180
- Fax
- (651) 385-6195
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3783 | MN | Primary |
Addresses
Primary practice location
426 West Ave
Red Wing, MN 55066-2473
Mailing address
426 West Ave
Red Wing, MN 55066-2473
Phone (651) 385-6180
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3783 | MN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710074208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "426 WEST AVE",
"city": "RED WING",
"state": "MN",
"postal_code": "550662473",
"telephone_number": "651-385-6180",
"fax_number": "651-385-6195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "426 WEST AVE",
"city": "RED WING",
"state": "MN",
"postal_code": "550662473",
"telephone_number": "651-385-6180",
"fax_number": "651-385-6195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERTOG",
"first_name": "GARY",
"middle_name": "EDWARD",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "3783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Wing, MN
Sources for this page
- 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.