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General NPI Number Information
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NPI Number | 1972868057
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Entity Type | Organization
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Legal Business Name | LIFE RIPPLES LLC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 1123 GRAND AVE SUITE 201
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City | SAINT PAUL
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State | MN
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Zip | 55105-2629
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Country | US
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Telephone | 612-567-0267
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 GRAND AVE SUITE 201
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City | SAINT PAUL
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State | MN
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Zip | 55105-2629
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Country | US
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Telephone | 612-567-0267
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. STEFANIE BAUER
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Credential | PSYD, LP
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Telephone | 612-567-0267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LP5037
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License Number State | MN
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