Healthcare Provider Details

I. General information

NPI: 1407535602
Provider Name (Legal Business Name): STEPHENIE MARIE WESCOUP PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MINNEHAHA AVE
MINNEAPOLIS MN
55404-3107
US

IV. Provider business mailing address

2101 MINNEHAHA AVE
MINNEAPOLIS MN
55404-3107
US

V. Phone/Fax

Practice location:
  • Phone: 612-721-9800
  • Fax:
Mailing address:
  • Phone: 612-721-9800
  • Fax: 612-721-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7260
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: