Melodie Sue Broden, PH.D., LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP4214 Issued in MN

Practice address

1 Veterans Dr
116B
Minneapolis, MN 55417-2309

Phone

(612) 467-5753

Fax

(612) 467-5309

NPI assigned

Jul 18, 2006

Last updated

Mar 31, 2008By the provider in NPPES

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

Other names 1

• Melodie Sue Vankampen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1144248063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 VETERANS DR",
            "address_2": "116B",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554172309",
            "telephone_number": "612-467-5753",
            "fax_number": "612-467-5309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VETERANS DR",
            "address_2": "116B",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554172309",
            "telephone_number": "612-467-5753",
            "fax_number": "612-467-5309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODEN",
        "first_name": "MELODIE",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "PH.D., LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELODIE",
            "last_name": "VANKAMPEN",
            "middle_name": "SUE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christie Brockman, DNP
• Cole Alan Brockman, OTD
• Erik Christopher Brockman, M.D.
• Lisa Kay Brockman, LGSW
• Taylor Brockman, MD
• Kevin Broder, MD
• Samantha Jane Broders, LGSW
• Karly Brodersen
• Angela Marie Brodzeller, OTR/L
• Matthew Scott Brogan, PA-C

• 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 Mar 31, 2008; 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.