MICHELLE K. PEMBLE (NPI# 1013116342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013116342 |
| Entity Type | Individual |
| Full Name | MICHELLE K. PEMBLE |
| Credential | PHD |
| Practice Address |
9555 Upland Ln N Maple Grove MN 55369 |
| Mailing Address |
8170 33rd Ave S # Ms 21110q Bloomington MN 55425-4516 |
| Practice Telephone | 9529931440 |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2018-06-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
LP4824 | MN | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 101 Martin Luther King Dr, Mankato, MN 560016460 | 5073856500 |
| Street Address |
9555 UPLAND LN N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568453926 | David C Sandell | Family Medicine | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2005-11-03 |
| 1114528593 | Dana Marie Feia | Physician Assistant | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-11-03 |
| 1235741364 | Relevium Chiropractic Care Pa | Chiropractor | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-08-19 |
| 1467012872 | Bethany Wysocki | Audiologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2019-06-18 |
| 1487168357 | Dusty Renee Hackler | Psychologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2017-11-29 |
| 1841722469 | Brynne Rainier Wilson Latterell | Family Medicine | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2017-04-02 |
| 1982150728 | Park Nicollet | Clinic/Center | 9555 Upland Ln N, Maple Grove, MN 66369 | 2016-08-31 |
| 1528514932 | David Chollar | Social Worker | 9555 Upland Ln N, Behavioral Health, 3rd Floor, Maple Grove, MN 55369-4485 | 2016-08-27 |
| 1770037574 | Biye Tambang | Nurse Practitioner | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2016-08-09 |
| 1174975528 | Park Nicollet | Clinic/Center | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2016-07-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063781771 | Julie Ann Gomer | Psychologist | 13700 Reimer Dr N Ste 220, Maple Grove, MN 55311-4548 | 2011-12-26 |
| 1588189955 | Kelly Joan Carlson Gibas | Psychologist | 13700 Reimer Dr N Ste 220, Maple Grove, MN 55311-4548 | 2017-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295347854 | Shining Light Skill Building LLC | Psychologist | 3055 Old Highway 8 Ste 106b, St. Anthony, MN 55418 | 2020-08-17 |
| 1245750652 | Sara Vaccarella | Psychologist | 331 W Superior St Ste 300, Duluth, MN 55802-4532 | 2017-06-27 |
| 1780124305 | Families First Counseling Services LLC | Psychologist | 103 S Kingston St, Caledonia, MN 55921-1315 | 2017-03-01 |
| 1598150930 | Nova Bhs | Psychologist | 521 Tanglewood Dr., Shoreview, MN 55126 | 2015-04-02 |
| 1801208566 | Rose Mary Boerboom | Psychologist | 415 N 1st St, #502, Minneapolis, MN 55401-4305 | 2014-05-28 |
| 1881015253 | Lucas Bosco Wanga | Psychologist | 715 Edgerton Street, Merrick Community Services, St. Paul, MN 55130 | 2014-01-02 |
| 1992145288 | Rowan P Buckley | Psychologist | 6825 Owen St Ste 201, Loretto, MN 55357-9713 | 2013-07-01 |
| 1750697587 | Megan Horwitz Plumstead | Psychologist | 1619 Dayton Ave Ste 327, Saint Paul, MN 55104-6495 | 2010-08-31 |
| 1073826913 | Scott Michael Jacoby | Psychologist | 2110 Lyndale Ave S, Minneapolis, MN 55405-3196 | 2010-07-20 |
| 1316178296 | Elaine Marie Miller | Psychologist | 3604 S Oak Cir, Saint Cloud, MN 56301-4616 | 2009-07-27 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
Please comment or provide details below to improve the information on MICHELLE K. PEMBLE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.