Healthcare Provider Details

I. General information

NPI: 1073032397
Provider Name (Legal Business Name): REBECCA RUTH BEDNAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 TOWER DR W STE 100
STILLWATER MN
55082-7609
US

IV. Provider business mailing address

1811 WEIR DR STE 270
WOODBURY MN
55125-6741
US

V. Phone/Fax

Practice location:
  • Phone: 651-390-5001
  • Fax:
Mailing address:
  • Phone: 651-714-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: