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JOHN L GUSTAVSON PH.D.

Clinical Neuropsychologist

Grand Junction, Colorado

Provider NPI: 1720068059

Provider Information:
 JOHN L GUSTAVSON PH.D.
Gender: M
Not Sole Proprietor

Practice Location:
2530 N 8TH ST SUITE 204 GRAND JUNCTION, CO 81501 US
Tel: 970-245-3505  Fax: --

Business Mailing Address:
2530 N 8TH ST SUITE 204 GRAND JUNCTION, CO 81501 US
Tel: 970-245-3505  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
CO987

Other Provider Identifiers:

IssuerNumberStateType
07987001CO05
C64326CO08
R18691CO02
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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