MEDICARE: DR. RENAE MARY REINARDY KRAGNESS PSY.D., LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	4707	MN

General Provider Information

NPI Number	:	1730399601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENAE MARY REINARDY KRAGNESS PSY.D., LP

Provider Business Mailing Address
First Line	:	14525 HIGHWAY 7
Second Line	:	SUITE 340
City	:	MINNETONKA
State	:	MN
Zip	:	55345-3734
Country	:	US
Telephone Number	:	952-367-4100
Fax Number	:	952-377-2828

Provider Business Practice Location Address
First Line	:	14525 HIGHWAY 7
Second Line	:	SUITE 340
City	:	MINNETONKA
State	:	MN
Zip	:	55345-3734
Country	:	US
Telephone Number	:	952-367-4100
Fax Number	:	952-377-2828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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