Active NPI
Jan Karen Witte-Bakken, PHD
- Clinical Psychologist
- Moorhead, MN
National Provider Identifier
1013001114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2205
- Practice address
- 891 Belsly Blvd
Moorhead, MN 56560-5055 - Phone
- (218) 287-4338
- Fax
- (218) 287-5928
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2205 | MN | Primary |
| Clinical Psychologist | 103TC0700X | 306 | ND |
Addresses
Primary practice location
891 Belsly Blvd
Moorhead, MN 56560-5055
Mailing address
891 Belsly Blvd
Moorhead, MN 56560-5055
Phone (218) 287-4338
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18691 | Other | ND | BLUE CROSS |
| 11082 | Other | ND | MEDICAID |
| 505252100 | Medicaid | MN |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2205 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487894400000",
"number": "1013001114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "891 BELSLY BLVD",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565605055",
"telephone_number": "218-287-4338",
"fax_number": "218-287-5928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "891 BELSLY BLVD",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565605055",
"telephone_number": "218-287-4338",
"fax_number": "218-287-5928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTE-BAKKEN",
"first_name": "JAN",
"middle_name": "KAREN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2017-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "2205",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "ND",
"license": "306",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "18691",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID",
"identifier": "11082",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "505252100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.