Healthcare Provider Details

I. General information

NPI: 1124452404
Provider Name (Legal Business Name): REBECCA STINSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S 2ND ST SUITE 180
MINNEAPOLIS MN
55454-1075
US

IV. Provider business mailing address

1300 S 2ND ST SUITE 180
MINNEAPOLIS MN
55454-1075
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-1500
  • Fax:
Mailing address:
  • Phone: 612-625-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: