Healthcare Provider Details

I. General information

NPI: 1982719118
Provider Name (Legal Business Name): BRUNETTI CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21308 JOHN MILLESS DR SUITE 101B
ROGERS MN
55374-4708
US

IV. Provider business mailing address

21308 JOHN MILLESS DR SUITE 101B
ROGERS MN
55374-4708
US

V. Phone/Fax

Practice location:
  • Phone: 763-428-4060
  • Fax: 763-428-1711
Mailing address:
  • Phone: 763-428-4060
  • Fax: 763-428-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP4169
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4169
License Number StateMN

VIII. Authorized Official

Name: DR. CHERI L BRUNETTI
Title or Position: OWNER
Credential: PH.D.
Phone: 763-428-4060