Provider Demographics
NPI:1467660084
Name:WETZEL, ROBIN LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LEE
Last Name:WETZEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5124
Mailing Address - Country:US
Mailing Address - Phone:612-296-3622
Mailing Address - Fax:612-588-9420
Practice Address - Street 1:4412 5TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5124
Practice Address - Country:US
Practice Address - Phone:612-296-3622
Practice Address - Fax:612-588-9420
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MNLP4796103TB0200X, 103TC0700X, 103TM1800X, 103TR0400X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth