Provider Demographics
NPI:1437793437
Name:OGREN, ROBERT W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:OGREN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 VERNON AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3139
Mailing Address - Country:US
Mailing Address - Phone:858-220-6502
Mailing Address - Fax:
Practice Address - Street 1:18322 MINNETONKA BLVD STE C
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-3258
Practice Address - Country:US
Practice Address - Phone:651-308-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical