Basic Information
| Provider Information | |||||||||
| NPI: | 1255462321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GATTO | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 33RD AVE | ||||||||
| Address2: | MS: 21110A | ||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554254516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528835129 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1811 WEIR DRIVE SUITE 355 | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551252273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512548580 | ||||||||
| FaxNumber: | 6517301700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC11157 | ME | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 25289 | MN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.