Provider Demographics
NPI:1720526759
Name:STEPPING STONE CLINIC, LLC
Entity type:Organization
Organization Name:STEPPING STONE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:701-741-7830
Mailing Address - Street 1:5637 COLFAX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1747
Mailing Address - Country:US
Mailing Address - Phone:701-741-7830
Mailing Address - Fax:612-886-3681
Practice Address - Street 1:6625 LYNDALE AVE S
Practice Address - Street 2:SUITE 500
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2373
Practice Address - Country:US
Practice Address - Phone:612-886-3704
Practice Address - Fax:612-886-3681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCORP00418261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty