Active NPI
Joelle Lynne Kallio, PSYD, LP
- Psychologist
- Saint Paul, MN
National Provider Identifier
1184722845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 4463
- Practice address
- 627 Snelling Ave S Ste 210
Saint Paul, MN 55116-1594 - Phone
- (651) 917-5040
- Fax
- (651) 917-3018
- NPI assigned
- Sep 20, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 4463 | MN | Primary |
Addresses
Primary practice location
627 Snelling Ave S Ste 210
Saint Paul, MN 55116-1594
Mailing address
627 Snelling Ave S Ste 210
Saint Paul, MN 55116-1594
Phone (651) 917-5040
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 215937600 | Medicaid | MN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4463 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516752000000",
"number": "1184722845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "627 SNELLING AVE S STE 210",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551161594",
"telephone_number": "651-917-5040",
"fax_number": "651-917-3018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "627 SNELLING AVE S STE 210",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551161594",
"telephone_number": "651-917-5040",
"fax_number": "651-917-3018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KALLIO",
"first_name": "JOELLE",
"middle_name": "LYNNE",
"credential": "PSYD, LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2018-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "4463",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "215937600",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.