Active NPI
Ewa X Peczalska, PHD LP
- Clinical Psychologist
- Stillwater, MN
National Provider Identifier
1326010596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1995
- Practice address
- 1500 Curve Crest Blvd W
Stillwater, MN 55082-6040 - Phone
- (651) 439-1234
- Fax
- (651) 351-0827
- NPI assigned
- Feb 2, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1995 | MN | Primary |
Addresses
Primary practice location
1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Mailing address
927 Churchill St W
Medical Staff Services
Stillwater, MN 55082-6605
Phone (651) 430-8537
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43728300 | Medicaid | WI |
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
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197504000000",
"number": "1326010596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "927 CHURCHILL ST W",
"address_2": "MEDICAL STAFF SERVICES",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550826605",
"telephone_number": "651-430-8537",
"fax_number": "651-430-4646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 CURVE CREST BLVD W",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550826040",
"telephone_number": "651-439-1234",
"fax_number": "651-351-0827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECZALSKA",
"first_name": "EWA",
"middle_name": "X",
"credential": "PHD LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-02",
"last_updated": "2007-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "1995",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43728300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stillwater, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.