Provider Demographics
NPI:1720370042
Name:MARTEL, RODNEY S (LP)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:S
Last Name:MARTEL
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 LINDEN HILLS BLVD.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1246
Mailing Address - Country:US
Mailing Address - Phone:612-928-0896
Mailing Address - Fax:
Practice Address - Street 1:4012 LINDEN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1246
Practice Address - Country:US
Practice Address - Phone:612-928-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2137103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist