Patricia R Gustafson, MS LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP2298 Issued in MN

Practice address

Madison East Center
Ste 352
Mankato, MN 56001

Phone

(507) 387-3195

NPI assigned

Apr 26, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594339200000",
    "number": "1710943840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8674",
            "address_2": "1230 E MAIN ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560028674",
            "telephone_number": "507-625-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MADISON EAST CENTER",
            "address_2": "STE 352",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-387-3195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "PATRICIA",
        "middle_name": "R",
        "credential": "MS LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-26",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP2298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "patriciagustafson@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "Madison East Center",
            "address_2": "Ste 352",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "56001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Iris Athenea Guerrero
• Maria Jesus Guerrero
• Tessa Guffey
• Brandon James Gustafson
• Lynn K Gustafson, DPM
• Kimberly Ann Haala, PH.D., L.P.
• Madison Claire Haberman
• Habilitative Services, LLC
• Jessica Hadler, MDT/RDH
• April Haedt

• Clinical Psychologist in Mankato, MN
• Providers in Mankato, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; 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.