Erica Eccles-Radtke, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP 5562 Issued in MN

Practice address

5625 Cenex Dr
Mail Stop 33100a
Inver Grove Heights, MN 55077-1724

Phone

(651) 552-2600

Fax

(651) 552-2614

NPI assigned

Oct 26, 2007

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

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 and National Provider Directory roles.

• Group Health, Inc.

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1710924683
  NPD (past)

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

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426723200000",
    "number": "1073792008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S - PO BOX 1309",
            "address_2": "MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "651-552-2600",
            "fax_number": "651-552-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5625 CENEX DR",
            "address_2": "MAIL STOP 33100A",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550771724",
            "telephone_number": "651-552-2600",
            "fax_number": "651-552-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECCLES-RADTKE",
        "first_name": "ERICA",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-26",
        "last_updated": "2015-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP 5562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. Bruce Lebert OD
• Abdullahi Mohamed Dubed, PHARM.D.
• Dynamic Path Psychological Services, LLC
• East Metro Family Practice, P.a.
• Stephen Gerard Ebert, SLP
• Andrew Eccles
• Christine Renee Eddy
• Alexandra Elena Edwards, AU.D.
• Amr Kadry Elshennawy, MEDICAL BILLER
• Emergentcare LLC.

• All providers in Inver Grove Heights, MN
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.