Provider Demographics
NPI:1699783381
Name:GALLO, GLORIA JEAN (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:JEAN
Last Name:GALLO
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 VINEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2627
Mailing Address - Country:US
Mailing Address - Phone:763-559-7084
Mailing Address - Fax:
Practice Address - Street 1:8085 WAYZATA BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1453
Practice Address - Country:US
Practice Address - Phone:763-546-1796
Practice Address - Fax:763-546-8264
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2964103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42F69GAOtherBLUE CROSS BLUE SHIELD PR