Provider Demographics
NPI:1972634251
Name:PIETIG, RONALD C (MA LP)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:PIETIG
Suffix:
Gender:M
Credentials:MA LP
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Mailing Address - Street 1:4660 SLATER RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4048
Mailing Address - Country:US
Mailing Address - Phone:952-431-1515
Mailing Address - Fax:763-559-9619
Practice Address - Street 1:15025 GLAZIER AV
Practice Address - Street 2:STE 236A
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124
Practice Address - Country:US
Practice Address - Phone:952-431-1515
Practice Address - Fax:763-559-9619
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2020-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNMNLP2724103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6281446OtherMEDICA INS
MN137247500Medicaid
MN27089PIOtherBCBS OF MN