Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | LP1896 | MN |
N | 103T00000X | Psychologist | LP1896 | MN |
Y | 103TC1900X | Counseling Psychologist | LP1896 | MN |
NPI | 1104260116 |
---|---|
Provider Name | Mr. Ronald Herman Weill |
First Address | Stillwater, MN 55082-5031 |
Second Address | Stillwater, MN 55082-5031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2013 |
Last Update Date | 21/10/2020 |