Erik De Water, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

LP6647 Issued in MN

Practice address

7373 France Ave S Ste 302
Edina, MN 55435-4538

Phone

(952) 595-5652

NPI assigned

Jan 7, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fraser Child and Family Center

  • Adolescent and Children Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1609922194
  Medicare reassignment NPD
• Proof Alliance

  • Clinical Psychologist
  • Saint Paul, MN
  • NPI 1699038265
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1013557057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4135 BENJAMIN DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551292233",
            "telephone_number": "646-334-8790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S STE 302",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354538",
            "telephone_number": "952-595-5652"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1876 Minnehaha Ave W",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551041029",
            "country_code": "US",
            "telephone_number": "651-917-2370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "721 Commerce Drive",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551255512",
            "country_code": "US",
            "telephone_number": "651-424-4003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE WATER",
        "first_name": "ERIK",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-07",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MN",
            "license": "LP6647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan F Dawson, DO
• Kate Stacken Dawson, CCC-SLP
• Day & Night Home Care Corp
• Patrick Renz De Guzman
• Ines De Llano, D.D.S.
• Amanda Deangelo, PT
• Daniel G Debban, CRNA
• Kimberly R Debeer, LICSW
• Amber Degraff
• Scott David Degregorio, M.D.

• Clinical Neuropsychologist in Edina, MN
• Providers in Edina, MN by specialty
• Clinical Neuropsychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.