DR. KERRY RYAN BROCKBERG (NPI# 1588179410) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588179410 |
| Entity Type | Individual |
| Full Name | DR. KERRY RYAN BROCKBERG |
| Credential | PH.D., LP |
| Practice Address |
2104 Northdale Blvd Nw Ste 220 Minneapolis MN 55433-3046 |
| Practice Telephone | 7635376000 |
| Mailing Telephone | 7635376000 |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2019-05-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | LP6410 | MN | Behavioral Health & Social Service Providers |
| Street Address |
2104 NORTHDALE BLVD NW STE 220 |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55433-3046 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417919002 | Gwen A Mccarthy | Nurse Anesthetist, Certified Registered | 2104 Northdale Blvd Nw Ste 220, Minneapolis, MN 55433-3046 | 2006-04-06 |
| 1801450291 | Nura Pa | Anesthesiology | 2104 Northdale Blvd Nw Ste 220, Minneapolis, MN 55433-3046 | 2019-05-01 |
| 1679084362 | Anne C Storey | Physical Therapist | 2104 Northdale Blvd Nw Ste 220, Minneapolis, MN 55433-3046 | 2017-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770134793 | Shelley Karee Peterson | Technician | 10311 Bittersweet St Nw, Coon Rapids, MN 55433 | 2019-09-20 |
| 1578122057 | Courtney Gau | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Dr. Nw, Coon Rapids, MN 55433 | 2019-06-10 |
| 1992275606 | Maliki Fofee Kamara | Licensed Practical Nurse | 2451 109th Ave Nw Apt. 1, Coon Rapids, MN 55433 | 2018-11-26 |
| 1992284541 | Sarah Vennes | Massage Therapist | 6400 Flying Cloud Dr, Suite 240, Eden Prairie, MN 55433 | 2018-08-13 |
| 1538646609 | Paige Prince | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Drive Nw, Coon Rapids, MN 55433 | 2018-07-23 |
| 1154828242 | Karin Lea Englund | Dentist | 9145 Springbrook Dr Nw Ste 100, Coon Rapids, MN 55433 | 2018-04-06 |
| 1235642513 | Vista Family Eye Care LLC | Optometrist | 9920 Foley Blvd Nw Ste 120, Coon Rapids, MN 55433 | 2017-11-09 |
| 1538697818 | Mohammed Nmn Ahmed | Internal Medicine | 9055 Spring Brook Drive, Allina Coon Rapids Clinic 9055, Coon Rapids, MN 55433 | 2017-05-31 |
| 1639531353 | Journi LLC | Nurse Practitioner | 277 Coon Rapids Blvd Suite 308, Coon Rapids, MN 55433 | 2016-03-22 |
| 1821457722 | Honorine Boyce | Licensed Practical Nurse | 2743 111th Ave. Nw, Coon Rapids, MN 55433 | 2016-02-19 |
| Find all providers in zip 55433 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407496516 | Liza N Meredith | Psychologist | Acacia Counseling and Wellness, 2724 University Ave Se Unit B, Minneapolis, MN 55414 | 2020-01-07 |
| 1194368191 | Luz Angelica Fehn Salinas | Psychologist | 1315 E24th St, Minneapolis, MN 55404 | 2019-10-22 |
| 1164071148 | Amy C Moran | Psychologist | Acacia Counseling & Wellness, 2724 University Ave., Unit B, Minneapolis, MN 55414 | 2019-09-11 |
| 1104482074 | Sanvello Behavioral Health Services, P.a. | Psychologist | 150 S 5th St Ste 825, Minneapolis, MN 55402-4200 | 2019-05-15 |
| 1033674726 | Kristina Marie Duncombe Lowe | Psychologist | 910 E 26th St Ste 410, Minneapolis, MN 55404-4512 | 2019-02-06 |
| 1083192223 | Krista Yucuis | Psychologist | 725 8th Ave Se, Minneapolis, MN 55414-1364 | 2018-07-31 |
| 1720564941 | Shani Ofrat | Psychologist | 1 Veterans Dr # 2g-128, Minneapolis, MN 55417-2309 | 2018-07-11 |
| 1962998997 | Steven Wolinski | Psychologist | 3830 Washburn Ave N, Minneapolis, MN 55412 | 2018-07-02 |
| 1497268122 | Andrea Lynn Potthoff | Psychologist | 7300 Metro Blvd Ste 640, Minneapolis, MN 55439-2313 | 2017-11-16 |
| 1871046912 | Christine E Bray | Psychologist | 1100 Washington Ave S, Suite 102, Minneapolis, MN 55415-1273 | 2016-07-25 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55433 |
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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.