Jacquelyn K. Wiersma, PH. D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP1583 Issued in MN

Practice address

3931 Auburn Dr
Minnetonka, MN 55305-5196

Phone

(952) 938-9499

Fax

(952) 938-9499

NPI assigned

Aug 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Jacquelyn K. Wiersma, PH. D., LP, PLLC

  • Clinical Psychologist
  • Minnetonka, MN
  • NPI 1770696726
  Medicare reassignment NPD Authorized official
• Nancy Hawkins & Associates

  • Clinical Psychologist
  • Saint Louis Park, MN
  • NPI 1831339290
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486080000000",
    "number": "1386757300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3931 AUBURN DR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055196",
            "telephone_number": "952-938-9499",
            "fax_number": "952-938-9499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3931 AUBURN DR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055196",
            "telephone_number": "952-938-9499",
            "fax_number": "952-938-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERSMA",
        "first_name": "JACQUELYN",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "PH. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2017-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP1583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keon Marcus Whittler Jr.
• Tamara Lynn Whyte Kasmarik, CNP
• Natalia Wiatros, DO
• Christie Ann Wick, LMFT
• Beth M. Wicklund, M.D.
• Michelle Lynn Wiersma, MS, CCC-SLP
• Katie McClellan Wigdahl, PA-C
• Sandra Wiita
• Jamie Wilcox, L.AC
• Wildflower Wellness Counseling

• Clinical Psychologist in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.