Brutlag, Gwen

Brutlag, Gwen is an sole proprietor health care provider with primary practice located at 220 W Washington Ave Wells Fargo Bank Building, Suite 204, Fergus Falls MN 56537-2569. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Brutlag, Gwen can be contacted via phone (218) 739-8761.

Contact Information

Primary practice address
220 W Washington Ave Wells Fargo Bank Building, Suite 204 Fergus Falls MN 56537-2569
Phone: (218) 739-8761
Fax: (218) 739-8581
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X LP 1204 Minnesota

Profile Details

NPI number 1275656431
LBN Legal business name Brutlag, Gwen
Credentials M.S., L.P.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 10th, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275656431 NPPES
Other 1991028 FED ID NUMBER
Other LP 1204 FED ID NUMBER

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