Individual
RONALD C PIETIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA LP
Contact information
Practice address
15025 GLAZIER AV, STE 236A, APPLE VALLEY, MN 55124
(952) 431-1515
(763) 559-9619
Mailing address
4660 SLATER RD, SUITE 225, EAGAN, MN 55122-4048
(952) 431-1515
(763) 559-9619
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
MNLP2724
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137247500
—
MN
01
—
27089PI
BCBS OF MN
MN
01
—
6281446
MEDICA INS
MN
Enumeration date
03/08/2007
Last updated
09/25/2020
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