Provider Demographics
NPI:1669577516
Name:VANSTELTEN, ANTOINETTE R (PSY D)
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:R
Last Name:VANSTELTEN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14115 JAMES RD
Mailing Address - Street 2:STE. 305
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-9468
Mailing Address - Country:US
Mailing Address - Phone:763-575-8086
Mailing Address - Fax:320-774-0415
Practice Address - Street 1:14115 JAMES RD
Practice Address - Street 2:STE. 305
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9468
Practice Address - Country:US
Practice Address - Phone:763-575-8086
Practice Address - Fax:763-774-0415
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MNLP4781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist