NPIMap

Organization Active NPI

North Therapy and Wellness PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Champlin, MN
National Provider Identifier
1265462212
Registry record updated Jul 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
NORTH THERAPY AND WELLNESS PA
Practice address
11165 Zealand Ave N
Champlin, MN 55316-3595
Phone
(763) 531-0566
Fax
(763) 531-0602
NPI assigned
Jul 4, 2006
Last updated
Jul 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2026

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

Authorized official

Name
Kirsten JankovichNPI 1679536973
Title
Owner
Phone
(763) 363-4826

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X MN Primary
Psychologist 103T00000X

Addresses

Primary practice location

11165 Zealand Ave N
Champlin, MN 55316-3595

Mailing address

11165 Zealand Ave N
Champlin, MN 55316-3595
Phone (763) 531-0566

Other identifiers 3

IdentifierTypeStateIssuer
30787NOOtherMNBLUE CROSS BLUE SHIELD
973518600MedicaidMN
30786NOOtherMNBLUE CROSS BLUE SHIEL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050221000501 MN Part B Supplier - Clinic/Group Practice 3870545668 Receives reassigned benefits from 5 practitioners
Practice locations: Champlin, MN

National Provider Directory

National Provider Directory

Locations

5615 Brooklyn Blvd
Ste 105
Brooklyn Ctr, MN 55429
Phone (763) 531-0566

11165 Zealand Ave N
Champlin, MN 55316
Phone (763) 531-0566

6120 Earle Brown Dr
Ste 520
Minneapolis, MN 55430
Phone (763) 531-0566

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1265462212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11165 ZEALAND AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163595",
            "telephone_number": "763-531-0566",
            "fax_number": "763-531-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11165 ZEALAND AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163595",
            "telephone_number": "763-531-0566",
            "fax_number": "763-531-0602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH THERAPY AND WELLNESS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "JANKOVICH",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-363-4826"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "30787NO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "973518600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIEL",
            "identifier": "30786NO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Champlin, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.