Active NPI
Marjorie Ann Van Slyke, PSY.D
- Professional Counselor
- St Louis Park, MN
National Provider Identifier
1093968703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CC00004
- Practice address
- 4021 Vernon Ave S
St Louis Park, MN 55416-2801 - Phone
- (952) 927-4609
- NPI assigned
- Oct 24, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CC00004 | MN | Primary |
Addresses
Primary practice location
4021 Vernon Ave S
St Louis Park, MN 55416-2801
Mailing address
4021 Vernon Ave S
St Louis Park, MN 55416-2801
Phone (952) 927-4609
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC00004 | MN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428969600000",
"number": "1093968703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4021 VERNON AVE S",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554162801",
"telephone_number": "952-927-4609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4021 VERNON AVE S",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554162801",
"telephone_number": "952-927-4609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN SLYKE",
"first_name": "MARJORIE",
"middle_name": "ANN",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-24",
"last_updated": "2015-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "CC00004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.