Basic Information
| Provider Information | |||||||||
| NPI: | 1861977787 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GADBOIS | ||||||||
| FirstName: | MAGDALEN | ||||||||
| MiddleName: | RENE | ||||||||
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| OtherLastName: | GADBOIS | ||||||||
| OtherFirstName: | MAGGIE | ||||||||
| OtherMiddleName: | RENE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1690 HIGHWAY 36 W APT 320 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551134013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513234397 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5200 FAIRVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550928013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519827000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2018 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 10189 | MN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.