Victoria Ruppenthal Stachura, MA, LP

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

LP 0855 Issued in MN

Practice address

9531 W 78TH St
Suite 340
Eden Prairie, MN 55344-3810

Phone

(952) 944-3161

Fax

(952) 944-0028

NPI assigned

Aug 15, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191801600000",
    "number": "1417960873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 LEA RD",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554381260",
            "telephone_number": "952-944-9864",
            "fax_number": "952-944-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9531 W 78TH ST",
            "address_2": "SUITE 340",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443810",
            "telephone_number": "952-944-3161",
            "fax_number": "952-944-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACHURA",
        "first_name": "VICTORIA",
        "middle_name": "RUPPENTHAL",
        "name_prefix": "Mrs.",
        "credential": "MA, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP 0855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "6153777",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "61-81168",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "ON146ST",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "70931",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Downs Spradlin, IBCLC
• Ashley Sprouse
• Isabel R St Dennis
• Allyra Liestelle St. Aubin
• David Scott St. John, M.D.
• Anika N Stafford
• Starkey Laboratories Inc (Ascent Audiology and Hearing Center)
• Starkey Labs
• Start Hearing, Inc.
• John Wayne Steely, M.D.

• Clinical Child & Adolescent Psychologist in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Clinical Child & Adolescent Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.