Provider Demographics
NPI:1699883363
Name:GJERDE, ELIZABETH A (MED)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GJERDE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:BROSSART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:3239 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-1304
Mailing Address - Country:US
Mailing Address - Phone:701-866-3969
Mailing Address - Fax:701-540-0106
Practice Address - Street 1:200 5TH ST S STE 301
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2768
Practice Address - Country:US
Practice Address - Phone:701-866-3969
Practice Address - Fax:701-540-0106
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND560-9-1-06-186101YP2500X, 101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor