| Organization Name: | STEPHANIE UNTIEDT, PHD, LLC |
| NPI Number: | 1073903886 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHANIE ANN UNTIEDT (PSCYHOLOGIST) |
| Mailing Address: | 5101 Olson Memorial Hwy Ste 4007 Golden Valley |
| State: | MN US |
| Postal Code: | 554225164 |
| Phone Number: | 7635957294 |
| Fax Number: | 7635957293 |
| NPI Enumeration Date: | 02/01/2015 |
| NPI Last Update Date: | 02/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 4599 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |