Provider Demographics
NPI:1629312830
Name:RUGGLES, MOLLY (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2629
Mailing Address - Country:US
Mailing Address - Phone:651-641-0177
Mailing Address - Fax:651-641-8635
Practice Address - Street 1:14665 GALAXIE AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4507
Practice Address - Country:US
Practice Address - Phone:952-431-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical