Healthcare Provider Details

I. General information

NPI: 1518915818
Provider Name (Legal Business Name): RALPH ROVNER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6607 18TH AVE S SUITE 101
MINNEAPOLIS MN
55423-2784
US

IV. Provider business mailing address

1638 UTAH DR S
MINNEAPOLIS MN
55426-1962
US

V. Phone/Fax

Practice location:
  • Phone: 952-451-3344
  • Fax:
Mailing address:
  • Phone: 952-451-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP 2554
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: