Active NPI
Kelsey Jean Van Vickle
- Speech-Language Pathologist
- Roseville, MN
National Provider Identifier
1316313091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 9542
- Practice address
- 1935 County Road B2 W Ste 100
Roseville, MN 55113-2722 - Phone
- (651) 636-4155
- Fax
- (651) 636-3595
- NPI assigned
- Aug 17, 2015
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 9542 | MN | Primary |
Addresses
Primary practice location
1935 County Road B2 W Ste 100
Roseville, MN 55113-2722
Mailing address
1947 Stinson Blvd
Minneapolis, MN 55418-4820
Phone (612) 229-4087
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 |
|---|---|---|---|
| 9542 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439769600000",
"number": "1316313091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1947 STINSON BLVD",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554184820",
"telephone_number": "612-229-4087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1935 COUNTY ROAD B2 W STE 100",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551132722",
"telephone_number": "651-636-4155",
"fax_number": "651-636-3595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN VICKLE",
"first_name": "KELSEY",
"middle_name": "JEAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-17",
"last_updated": "2015-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "9542",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.