Provider Demographics
NPI:1972580579
Name:GETZ, REBECCA KRISTINE (PSYD LP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KRISTINE
Last Name:GETZ
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1603
Mailing Address - Country:US
Mailing Address - Phone:651-644-4100
Mailing Address - Fax:651-644-4885
Practice Address - Street 1:2383 UNIVERSITY AVE W
Practice Address - Street 2:STE 200
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1603
Practice Address - Country:US
Practice Address - Phone:651-644-4100
Practice Address - Fax:651-644-4885
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4515103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN298L3GEOtherBCBS OF MN
MN832955900Medicaid
MN680001992Medicare ID - Type Unspecified