Healthcare Provider Details

I. General information

NPI: 1689732851
Provider Name (Legal Business Name): RONALD JOSEPH WUTCHIETT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 FRANCE AVE. SO. SUITE 103
EDINA MN
55434
US

IV. Provider business mailing address

10375 WILDWOOD RD
BLOOMINGTON MN
55437-2297
US

V. Phone/Fax

Practice location:
  • Phone: 952-885-9018
  • Fax: 952-885-9018
Mailing address:
  • Phone: 952-885-9018
  • Fax: 952-885-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP0219
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberLP0219
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberLP0219
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: