Carol Elaine Mecklenburg, PHD LP

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

4962 Issued in MN

Practice address

2399 Ariel St N Ste D
Maplewood, MN 55109-2202

Phone

(651) 770-1311

Fax

(651) 770-1879

NPI assigned

Oct 14, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223942400000",
    "number": "1144472853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 HAMLINE AVE S",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162238",
            "telephone_number": "651-431-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2399 ARIEL ST N STE D",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092202",
            "telephone_number": "651-770-1311",
            "fax_number": "651-770-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MECKLENBURG",
        "first_name": "CAROL",
        "middle_name": "ELAINE",
        "credential": "PHD LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-14",
        "last_updated": "2008-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "4962",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "MN",
            "license": "254940",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenna McMahon
• Dennis M McMahon, DDS
• Douglas F McMahon, M.D.
• Amanda Kay McNaughton, OTRL
• Nora Lynn McPherson, RN, CNS-BC
• Kimberly A Meegan
• Brian Martin Meger, PHARMD, RPH
• Bonnita Helen Gruell Meingast, OTRL
• Georgiann Marie Melton, PSYCHOTHERAPIST
• Penny Menke, CNM

• Clinical Child & Adolescent Psychologist in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Clinical Child & Adolescent Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.