Provider Demographics
NPI:1972230845
Name:RUPPERT, STEPHANIE ELIZABETH (LMFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:RUPPERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-0547
Mailing Address - Country:US
Mailing Address - Phone:651-775-9804
Mailing Address - Fax:844-364-7181
Practice Address - Street 1:6448 MAIN ST STE 1AND3
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-7068
Practice Address - Country:US
Practice Address - Phone:651-775-9804
Practice Address - Fax:844-364-7181
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist