Healthcare Provider Details

I. General information

NPI: 1285597120
Provider Name (Legal Business Name): ELIZABETH RONGITSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426-4702
US

IV. Provider business mailing address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426-4702
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-9404
  • Fax:
Mailing address:
  • Phone: 952-993-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25743
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: