Individual
DR. STEPHANIE ANN UNTIEDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., L.P.
Contact information
Practice address
4343 ABBOTT AVE S, MINNEAPOLIS, MN 55410-1442
(612) 206-1465
Mailing address
4343 ABBOTT AVE S, MINNEAPOLIS, MN 55410-1442
(612) 206-1465
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
4599
MN
103TC1900X
Counseling Psychologist
Primary
4599
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
385486800
—
MN
Enumeration date
06/09/2006
Last updated
02/01/2015
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