Provider Demographics
NPI:1730214883
Name:RUPPENTHAL, NANCY L (LICSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:RUPPENTHAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 CALIFORNIA ST NE
Mailing Address - Street 2:#200C
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3348
Mailing Address - Country:US
Mailing Address - Phone:612-789-2653
Mailing Address - Fax:
Practice Address - Street 1:2205 CALIFORNIA ST NE
Practice Address - Street 2:#200C
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3348
Practice Address - Country:US
Practice Address - Phone:612-789-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical