Active NPI
Carol Rogers-Tanner, MS LP
- Clinical Psychologist
- Maplewood, MN
National Provider Identifier
1194775841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP2901
- Practice address
- 2399 Ariel St N Ste D
Maplewood, MN 55109-2202 - Phone
- (651) 770-1311
- Fax
- (651) 770-1879
- NPI assigned
- May 11, 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP2901 | MN | Primary |
Addresses
Primary practice location
2399 Ariel St N Ste D
Maplewood, MN 55109-2202
Mailing address
2399 Ariel St N Ste D
Maplewood, MN 55109-2202
Phone (651) 770-1311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 857051500 | 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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2901 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435104000000",
"number": "1194775841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"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"
},
{
"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": "ROGERS-TANNER",
"first_name": "CAROL",
"credential": "MS LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-11",
"last_updated": "2015-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP2901",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "857051500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.