Angela Rae Nelson, PSY.D., LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

5086 Issued in MN

Practice address

1650 W End Blvd
Suite 100
St Louis Park, MN 55416-5367

Phone

(952) 856-8452

Fax

(952) 487-0380

NPI assigned

Jul 6, 2009

Last updated

Apr 7, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Angela Rae Gawron Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 23, 2018 through Apr 23, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1246838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428364800000",
    "number": "1083843593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18635 37TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554462856",
            "telephone_number": "763-355-4558",
            "fax_number": "763-478-9294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 W END BLVD",
            "address_2": "SUITE 100",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165367",
            "telephone_number": "952-856-8452",
            "fax_number": "952-487-0380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "ANGELA",
        "middle_name": "RAE",
        "credential": "PSY.D., LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-06",
        "last_updated": "2015-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "5086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "GAWRON",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer M Neist, R.N.
• Stephanie Renae Neitz, PA-C
• Eric M Nelsen, MD
• Travis Alan Nelsen, MA, LMFT
• Alec Joseph Nelson, MAPT
• Curtis Nelson
• Elizabeth Nelson
• Emilie Anne Nelson, DO
• Gemma Nelson
• Janey Dorgan Nelson, M.A., LSW

• Psychologist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.