Provider Demographics
NPI:1255155834
Name:RONNING, BENJAMIN WAYNE (LPCC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WAYNE
Last Name:RONNING
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 SUZANNE AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2312
Mailing Address - Country:US
Mailing Address - Phone:218-205-4213
Mailing Address - Fax:
Practice Address - Street 1:1915 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3104
Practice Address - Country:US
Practice Address - Phone:800-336-5973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional