Active NPI
Eric Rudrud, PH.D.
- Intellectual & Developmental Disabilities Psychologist
- Saint Cloud, MN
National Provider Identifier
1770815417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual & Developmental Disabilities Psychologist
- License
- LP2741
- Practice address
- 1913 14TH St S
Saint Cloud, MN 56301-4855 - Phone
- (320) 259-1144
- NPI assigned
- Feb 5, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | LP2741 | MN | Primary |
Addresses
Primary practice location
1913 14TH St S
Saint Cloud, MN 56301-4855
Mailing address
1913 14TH St S
Saint Cloud, MN 56301-4855
Phone (320) 259-1144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2741 | MN | MD | Intellectual & Developmental Disabilities Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265328000000",
"number": "1770815417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1913 14TH ST S",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563014855",
"telephone_number": "320-259-1144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1913 14TH ST S",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563014855",
"telephone_number": "320-259-1144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDRUD",
"first_name": "ERIC",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-02-05",
"last_updated": "2010-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "MN",
"license": "LP2741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.