Active NPI
Mandie Bolton Kender
- Rehabilitation Psychologist
- West Saint Paul, MN
National Provider Identifier
1194034579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Psychologist
- License
- 179584
- Practice address
- 1740 Livingston Ave
West Saint Paul, MN 55118-3912 - Phone
- (651) 457-2248
- NPI assigned
- Oct 1, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | 179584 | MN | Primary |
Addresses
Primary practice location
1740 Livingston Ave
West Saint Paul, MN 55118-3912
Mailing address
11 Marquette Ave
#601
Minneapolis, MN 55401
Phone (612) 232-4321
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 |
|---|---|---|---|
| 179584 | MN | MD | Rehabilitation Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285891200000",
"number": "1194034579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 MARQUETTE AVE",
"address_2": "#601",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55401",
"telephone_number": "612-232-4321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1740 LIVINGSTON AVE",
"city": "WEST SAINT PAUL",
"state": "MN",
"postal_code": "551183912",
"telephone_number": "651-457-2248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLTON KENDER",
"first_name": "MANDIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-01",
"last_updated": "2010-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "MN",
"license": "179584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.