Active NPI
Scott Hanneman, PH.D., L.P
- Clinical Psychologist
- St Louis Park, MN
National Provider Identifier
1043608037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5855
- Practice address
- 3525 Monterey Dr
St Louis Park, MN 55416-5275 - Phone
- (952) 993-6200
- Fax
- (952) 993-5599
- NPI assigned
- Dec 30, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5855 | MN | Primary |
Addresses
Primary practice location
3525 Monterey Dr
St Louis Park, MN 55416-5275
Mailing address
3525 Monterey Dr
St Louis Park, MN 55416-5275
Phone (952) 993-6200
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419897600000",
"number": "1043608037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3525 MONTEREY DR",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554165275",
"telephone_number": "952-993-6200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3525 MONTEREY DR",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554165275",
"telephone_number": "952-993-6200",
"fax_number": "952-993-5599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANNEMAN",
"first_name": "SCOTT",
"credential": "PH.D., L.P",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-30",
"last_updated": "2014-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "5855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.