Individual
RUDOLPH ROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
560 CONCORDIA AVE, STE 1100, SAINT PAUL, MN 55103-2443
(651) 325-2766
Mailing address
5933 29TH PL N, CRYSTAL, MN 55422-2559
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1420
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113090
UCAREBHP
MN
Enumeration date
11/22/2006
Last updated
07/09/2007
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