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General NPI Number Information
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NPI Number | 1437793437
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Entity Type | Individual
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Provider Name | ROBERT W OGREN PSYD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 18322 MINNETONKA BLVD STE C
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City | WAYZATA
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State | MN
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Zip | 55391-3258
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Country | US
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Telephone | 651-308-2290
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Fax |
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Provider Business Mailing Address
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Address Line | 4206 VERNON AVE S
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-3139
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Country | US
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Telephone | 858-220-6502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP6457
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License Number State | MN
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