Kaylie Broberg

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

3775 Issued in MN

Practice address

9800 Shelard Pkwy Ste 115
Plymouth, MN 55441-6411

Phone

(651) 447-7507

Fax

(763) 432-6001

NPI assigned

Nov 16, 2017

Last updated

Dec 28, 2021By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Vanda Counseling and Psychological Services

  • Community/Behavioral Health Agency
  • Golden Valley, MN
  • NPI 1295131779
  NPD (past)

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

{
    "created_epoch": "1510790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1053824748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9800 SHELARD PKWY STE 115",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554416411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9800 SHELARD PKWY STE 115",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554416411",
            "telephone_number": "651-447-7507",
            "fax_number": "763-432-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROBERG",
        "first_name": "KAYLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-16",
        "last_updated": "2021-12-28",
        "certification_date": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Caryl Breyer, MA, LADC, LPCC
• Jessica Bridgeford
• Brimhall Plymouth (Williams & Wimmer DDS)
• Vincent Alexander Brinker
• Susan E Broadwell, MA.PSY.D.
• Brookdale Senior Living Communities, Inc. (Brookdale Plymouth)
• Andrew Brooks, MD
• Kelly Lynn Brouwer, DPT
• Sharon Lynn Brouwer, MA CCC SLP
• Alissya Brown

• Marriage & Family Therapist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.