Provider Demographics
NPI:1417001637
Name:DEGROOT, DEAN RALPH (MS)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:RALPH
Last Name:DEGROOT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 BUCHANAN ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2274
Mailing Address - Country:US
Mailing Address - Phone:612-789-9596
Mailing Address - Fax:
Practice Address - Street 1:3232 BUCHANAN ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-2274
Practice Address - Country:US
Practice Address - Phone:612-789-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1218103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist