Provider Demographics
NPI:1518915818
Name:ROVNER, RALPH (PHD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:ROVNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 UTAH DR S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1962
Mailing Address - Country:US
Mailing Address - Phone:952-451-3344
Mailing Address - Fax:
Practice Address - Street 1:6607 18TH AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55423-2784
Practice Address - Country:US
Practice Address - Phone:952-451-3344
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2554103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical