Provider Demographics
NPI:1962414144
Name:PLUTH, MARCELLA (MS, LP)
Entity type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:
Last Name:PLUTH
Suffix:
Gender:F
Credentials:MS, LP
Other - Prefix:MS
Other - First Name:MARCELLA
Other - Middle Name:PLUTH
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LP
Mailing Address - Street 1:3395 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-3765
Mailing Address - Country:US
Mailing Address - Phone:952-939-0396
Mailing Address - Fax:952-548-8760
Practice Address - Street 1:3395 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-3765
Practice Address - Country:US
Practice Address - Phone:952-939-0396
Practice Address - Fax:952-548-8760
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2083103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1020045OtherPREFERRED ONE
MN55P77ROOtherBLUE CROSS BLUE SHIELD
MN128337OtherUCARE
MNHP37852OtherHEALTH PARTNERS
MN62-63834OtherMEDICA
MN20659OtherSIOUX VALLEY HEALTH
MN843253800Medicaid