DUSTY RENEE HACKLER (NPI# 1487168357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487168357 |
| Entity Type | Individual |
| Full Name | DUSTY RENEE HACKLER |
| Credential | PHD |
| Practice Address |
9555 Upland Ln N Maple Grove MN 55369-4485 |
| Mailing Address |
9555 Upland Ln N Mailstop:62m03b Maple Grove MN 55369-4485 |
| Practice Telephone | 9529933307 |
| Mailing Telephone | 9529933307 |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2017-11-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
LP6194 | MN | Behavioral Health & Social Service Providers |
| Street Address |
9555 UPLAND LN N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-4485 |
| 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 |
| 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 |
| 1780038299 | Elizabeth Patricia Kratz | Nurse Practitioner | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2016-04-20 |
| 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 | 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 |
|---|---|---|---|---|
| 1316180011 | Brenda Diane Brant | Psychologist | 18473 97th Pl N, Maple Grove, MN 55311-1368 | 2009-04-09 |
| 1336118603 | Jon Norman Jensen | Psychologist | 7840 Vinewood Lane, Maple Grove, MN 55369-4655 | 2006-03-17 |
| 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 |
| 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 |
| 1417173105 | Thomson F Davis | Psychologist | 3537 Lake Elmo Ave N, Suite 190, Lake Elmo, MN 55042-7405 | 2007-04-18 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
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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.