Active NPI
Roger Lee Reddan, M.A., L.P.
- Counseling Psychologist
- Plymouth, MN
National Provider Identifier
1326110438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- LP0841
- Practice address
- 12805 Highway 55
Suite 211
Plymouth, MN 55441-3859 - Phone
- (763) 550-9005
- Fax
- (763) 559-2118
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | LP0841 | MN | Primary |
Addresses
Primary practice location
12805 Highway 55
Suite 211
Plymouth, MN 55441-3859
Mailing address
12805 Highway 55
Suite 211
Plymouth, MN 55441-3859
Phone (763) 550-9005
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP0841 | MN | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minnesota Psychological Resources | Counseling | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326110438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12805 HIGHWAY 55",
"address_2": "SUITE 211",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554413859",
"telephone_number": "763-550-9005",
"fax_number": "763-559-2118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12805 HIGHWAY 55",
"address_2": "SUITE 211",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554413859",
"telephone_number": "763-550-9005",
"fax_number": "763-559-2118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDDAN",
"first_name": "ROGER",
"middle_name": "LEE",
"credential": "M.A., L.P.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MN",
"license": "LP0841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.