| Stephanie Untiedt, Phd, Llc | |
|
5101 Olson Memorial Hwy Ste 4007 Golden Valley MN 55422-5164 | |
| (763) 595-7294 | |
| (763) 595-7293 |
| Full Name | Stephanie Untiedt, Phd, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 5101 Olson Memorial Hwy Ste 4007, Golden Valley, Minnesota |
| Authorized Official Name and Position | Stephanie Ann Untiedt (PSCYHOLOGIST) |
| Authorized Official Contact | 7635957294 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stephanie Untiedt, Phd, Llc 5101 Olson Memorial Hwy Ste 4007 Golden Valley MN 55422-5164 Ph: (763) 595-7294 | Stephanie Untiedt, Phd, Llc 5101 Olson Memorial Hwy Ste 4007 Golden Valley MN 55422-5164 Ph: (763) 595-7294 |
| NPI Number | 1073903886 |
|---|---|
| Provider Enumeration Date | 02/01/2015 |
| Last Update Date | 02/01/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073903886 | NPI | - | NPPES |
| 1093756041 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 4599 (Minnesota) | Primary |
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