Derek Prowe LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP5238 Issued in MN

Legal business name

DEREK PROWE LLC

Practice address

4749 Chicago Ave
Suite 1D
Minneapolis, MN 55407-3556

Phone

(612) 656-9122

NPI assigned

Feb 29, 2016

Organization subpart

No

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

Authorized official

Name

Derek Evan Prowe, PSYDNPI 1699924639

Title

Owner

Phone

(612) 656-9122

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derek Evan Prowe, PSYD

  • Psychologist
  • Minneapolis, MN
  • NPI 1699924639
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456704000000",
    "number": "1083074371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4749 CHICAGO AVE",
            "address_2": "SUITE 1D",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073556",
            "telephone_number": "612-656-9122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4749 CHICAGO AVE",
            "address_2": "SUITE 1D",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073556",
            "telephone_number": "612-656-9122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK PROWE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-29",
        "last_updated": "2016-02-29",
        "status": "A",
        "authorized_official_last_name": "PROWE",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "EVAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-656-9122",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP5238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Marie Dequaine, LSW
• Keith Leslie Deraad, CPRP
• Amanda Kay Derasmi, DO
• Pamela Kay Derby, FNP
• Tyler Dercks
• Anogsa Deressa
• Ebisie Geneti Deressa, MD
• Galen Dereu, LADC, LPCC
• Terryl Derimanoczy
• Margaret Mary Dering

• Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.