Provider Demographics
NPI:1710055991
Name:GARCIA-PELTONIEMI, ROSA ESTHER (PHD, LP)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:ESTHER
Last Name:GARCIA-PELTONIEMI
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6108
Mailing Address - Country:US
Mailing Address - Phone:651-644-9047
Mailing Address - Fax:
Practice Address - Street 1:717 E RIVER PKWY
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0369
Practice Address - Country:US
Practice Address - Phone:612-436-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1646103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLP1646OtherPSYCHOLOGY LICENSE