Healthcare Provider Details

I. General information

NPI: 1689496986
Provider Name (Legal Business Name): HANNAH RUTH REPP PSYD. LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNAH RUTH GODBOUT PSYD, LP

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 SOUTH 5TH STREET
SAINT PETER MN
56082
US

IV. Provider business mailing address

722 SOUTH 5TH STREET
SAINT PETER MN
56082
US

V. Phone/Fax

Practice location:
  • Phone: 651-210-5535
  • Fax:
Mailing address:
  • Phone: 651-210-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP5472
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: