Healthcare Provider Details

I. General information

NPI: 1225577075
Provider Name (Legal Business Name): SOREN NICOLE RUPPELIUS LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HARMON PL
MINNEAPOLIS MN
55403-2043
US

IV. Provider business mailing address

1201 HARMON PL
MINNEAPOLIS MN
55403-2043
US

V. Phone/Fax

Practice location:
  • Phone: 612-432-3261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: