Provider Demographics
NPI:1699988972
Name:RINNE, MICHELE (MS ED, LP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:RINNE
Suffix:
Gender:F
Credentials:MS ED, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 NE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744
Mailing Address - Country:US
Mailing Address - Phone:218-360-5503
Mailing Address - Fax:218-326-2100
Practice Address - Street 1:421 NE 9TH AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3130
Practice Address - Country:US
Practice Address - Phone:218-313-1120
Practice Address - Fax:218-259-3947
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1699988972Medicaid
MN287852600OtherIMCARE
MN54B50RIOtherBCBS OF MINNESOTA
MN62 55844OtherUNITED BEHAVIORAL SYSTEMS
MN287852600Medicaid
MN1008737OtherPREFERRED ONE