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Individual

MRS. VICTORIA RUPPENTHAL STACHURA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, LP

Contact information

Practice address
9531 W 78TH ST, SUITE 340, EDEN PRAIRIE, MN 55344-3810
(952) 944-3161
(952) 944-0028
Mailing address
8100 LEA RD, BLOOMINGTON, MN 55438-1260
(952) 944-9864
(952) 944-0028

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
LP 0855
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
61-81168
MEDICA
MN
01
6153777
UBH
MN
01
70931
UHC
MN
01
ON146ST
BCBS
MN
Enumeration date
08/15/2006
Last updated
10/08/2007
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