Provider Demographics
NPI:1861977787
Name:GADBOIS, MAGDALEN RENE
Entity type:Individual
Prefix:
First Name:MAGDALEN
Middle Name:RENE
Last Name:GADBOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:RENE
Other - Last Name:GADBOIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1690 HIGHWAY 36 W APT 320
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4013
Mailing Address - Country:US
Mailing Address - Phone:651-323-4397
Mailing Address - Fax:
Practice Address - Street 1:5200 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8013
Practice Address - Country:US
Practice Address - Phone:651-982-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist