DR. JACKIE ENGEBRETSON (NPI# 1134598667) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134598667 |
| Entity Type | Individual |
| Full Name | DR. JACKIE ENGEBRETSON |
| Credential | PHD, LP |
| Practice Address |
3850 Park Nicollet Blvd St Louis Park MN 55416-2527 |
| Mailing Address |
17833 Cobblestone Way Eden Prairie MN 55347-2139 |
| Practice Telephone | 9529931000 |
| Mailing Telephone | 7656090888 |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2015-09-15 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
LP5917 | MN | Behavioral Health & Social Service Providers |
| Street Address |
3850 PARK NICOLLET BLVD |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55416-2527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487659587 | Debra Ann Rustad | Nurse Practitioner | 3850 Park Nicollet Blvd, Park Nicollet Clinic--senior Services-- 3rd Floor, St Louis Park, MN 55416-2527 | 2005-06-15 |
| 1386280030 | Melissa Jean Neiert | Social Worker | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-11-18 |
| 1083261101 | Annemarie Rose Kettler | Dietitian, Registered | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-08-22 |
| 1427601772 | Michaela Rae Schleinz | Occupational Therapist | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-07-16 |
| 1720545627 | Rose Alicia Crider | Dietitian, Registered | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-02-27 |
| 1114435773 | Adam James Uithoven | Physician Assistant | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2018-01-17 |
| 1285140442 | Jessica Mae Brabender | Nurse Practitioner | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2017-12-22 |
| 1043729064 | Grace Marie Irish | Nurse Practitioner | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2017-09-21 |
| 1760908131 | Elin Christine Pool | Physician Assistant | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2017-08-17 |
| 1912422718 | Kathleen Therese Guinee Holman | Nurse Practitioner | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2017-08-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
| 1598307860 | Ayman Abulaziz Mohamed | Counselor | 4326 Park Glen Rd, St Louis Park, MN 55416 | 2019-10-08 |
| 1831758929 | Ally Group Homes LLC | Assisted Living Facility | 2944 Princeton Ave South, Saint Louis Park, MN 55416 | 2019-06-11 |
| 1609371525 | Heather Margaret Flatgard | Chiropractor | 5407 Excelsior Blvd Ste D, St Louis Park, MN 55416 | 2018-03-25 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1316469760 | Evert Ray Boyd | Psychologist | 3200 Highway 100 S., Groves Academy, St Louis Park, MN 55416 | 2017-07-07 |
| 1861941684 | Amanda Marie Tapper | Marriage & Family Therapist | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416 | 2016-09-22 |
| 1326410416 | Clear Health Chiropractic LLC | Chiropractor | 5614 W 36th St, St. Louis Park, MN 55416 | 2015-10-28 |
| 1568897833 | Kay Elizabeth Lichtenberger | Physical Therapist | 4415 W 36.5 St, St. Louis Park, MN 55416 | 2013-09-05 |
| 1710221510 | Aaron Christopher Oppelt | Counselor | 1665 Utica Ave South - Suite 100, Saint Louis Park, MN 55416 | 2012-11-16 |
| Find all providers in zip 55416 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376524538 | Jordan Lynn Hart | Psychologist | 5353 Gamble Dr, Suite 110, St Louis Park, MN 55416-1509 | 2005-11-07 |
| 1144604950 | Olitzky Pediatric Psychological Services LLC | Psychologist | 4700 Park Glen Rd, St Louis Park, MN 55416-5701 | 2015-07-13 |
| 1720121254 | Sheila E Merzer | Psychologist | 4820 Minnetonka Blvd, Suite 200, St Louis Park, MN 55416-5707 | 2007-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316405202 | Q Collective, LLC | Psychologist | 3413 Wilshire Pl Ne, Minneapolis, MN 55418-1447 | 2019-03-09 |
| 1043714199 | Julianna Sapienza | Psychologist | 2545 Chicago Ave Ste 217, Minneapolis, MN 55404-4556 | 2018-03-22 |
| 1942758701 | Dana Hoehn | Psychologist | 4636 Lyndale Ave S, Lower Unit, Minneapolis, MN 55419-5302 | 2016-09-21 |
| 1942687397 | Hope Psychology Practice, LLC | Psychologist | 2720 W. 43rd St., Suite 205, Minneapolis, MN 55410 | 2015-05-05 |
| 1861737041 | Decisionpoint Behavioral Health, Inc. | Psychologist | 206 S Broadway, Suite 411a, Rochester, MN 55904-6502 | 2012-11-29 |
| 1063725166 | Thomas Robert Lutz | Psychologist | 1125 Ramsey St, Hastings, MN 55033-2811 | 2010-07-17 |
| 1366755597 | Kristin L Ballard | Psychologist | 4005 W 65th St Ste 110, Edina, MN 55435-1700 | 2010-07-16 |
| 1316180011 | Brenda Diane Brant | Psychologist | 18473 97th Pl N, Maple Grove, MN 55311-1368 | 2009-04-09 |
| 1457554735 | Catherine Lawrence Scharlau | Psychologist | 1295 Bandana Blvd. North, Aspen Medical Group-behavioral Health, St. Paul, MN 55108 | 2007-06-06 |
| 1710196522 | Bill J Duke | Psychologist | 420 Center Ave Ste 7, Moorhead, MN 56560-1962 | 2007-05-21 |
| Find all providers with the same taxonomy | ||||
| City | ST LOUIS PARK |
| Zip Code | 55416 |
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| 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.