Provider Demographics
NPI:1508207044
Name:RUDNINGEN, DEBORAH A (LPC, LADC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:RUDNINGEN
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 STRAWBERRY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472-2291
Mailing Address - Country:US
Mailing Address - Phone:218-833-7636
Mailing Address - Fax:218-543-4394
Practice Address - Street 1:10010 STRAWBERRY LAKE RD
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472-2291
Practice Address - Country:US
Practice Address - Phone:218-833-7636
Practice Address - Fax:218-543-4394
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303570101YA0400X
MN01317101YP2500X
MNCC00963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional