| Doctor Name: | THERESA L GUNDERSON |
| NPI Number: | 1043298060 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | LP4545 |
| Business Practice Address: | Madison East Center Suite 352 Mankato Clinic Department Of Psychiatry Mankato, MN - 56001 |
| Business Phone Number: | 5073873195 |
| Business Fax Number: | |
| Mailing Address: | Po Box 8674, 1230 E Main St Mankato Clinic Ltd MANKATO |
| State: | MN |
| Postal Code: | 560028674 |
| Phone Number: | 5076251811 |
| Fax Number: | |
| NPI Enumeration Date: | 01/09/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP4545 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |