Provider Demographics
NPI:1336158260
Name:STEELE, ROBERT RONALD (MA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RONALD
Last Name:STEELE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NORTH WEST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401
Mailing Address - Country:US
Mailing Address - Phone:218-339-3235
Mailing Address - Fax:218-829-1368
Practice Address - Street 1:520 NW 5TH STREET
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401
Practice Address - Country:US
Practice Address - Phone:218-829-3235
Practice Address - Fax:218-829-1368
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2757103T00000X
MNLP2757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-20769OtherUNITED BEHAVIORAL HEALTH
MN117952OtherUCARE
MN57305STOtherBLUE CROSS BLUE SHIELD
MN887347000Medicaid
MNHP18245OtherHEALTH PARTNERS