Active NPI
Jessica Lynn Gourneau, PH.D., LP
- Clinical Psychologist
- Saint Paul, MN
National Provider Identifier
1073993341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP 8592
- Practice address
- 579 Wells St
Saint Paul, MN 55130-4134 - Phone
- (651) 793-3803
- Fax
- (651) 793-3809
- NPI assigned
- Jun 2, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP 8592 | MN | Primary |
Addresses
Primary practice location
579 Wells St
Saint Paul, MN 55130-4134
Mailing address
7401 Metro Blvd
Ste 525
Edina, MN 55439-3059
Phone (651) 793-3803
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 |
|---|---|---|---|
| LP 8592 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555545600000",
"number": "1073993341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7401 METRO BLVD",
"address_2": "STE 525",
"city": "EDINA",
"state": "MN",
"postal_code": "554393059",
"telephone_number": "651-793-3803",
"fax_number": "651-793-3809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "579 WELLS ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551304134",
"telephone_number": "651-793-3803",
"fax_number": "651-793-3809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOURNEAU",
"first_name": "JESSICA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PH.D., LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-02",
"last_updated": "2019-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP 8592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.