Active NPI
Jessica Rose Vander Weyst, PSYD, LP
- Clinical Psychologist
- St. Cloud, MN
National Provider Identifier
1386947653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP5304
- Practice address
- 1406 6TH Avenue North
St. Cloud Hospital
St. Cloud, MN 56303-1901 - Phone
- (320) 251-2700
- NPI assigned
- Dec 8, 2010
- 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 | LP5304 | MN | Primary |
Addresses
Primary practice location
1406 6TH Avenue North
St. Cloud Hospital
St. Cloud, MN 56303-1901
Mailing address
1900 Centracare Circle #2475
Centracare Health Plaza
St. Cloud, MN 56303
Phone (320) 229-5199
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP5304 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vander Weyst Psychological Wellness, LLC | Clinical | Current | Accepting new patients |
| St. Cloud Hospital | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Clinical Psychologist
- Plain City, OH
- NPI 1336085562
-
- Rehabilitation Hospital Unit
- Saint Cloud, MN
- NPI 1619934627
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291766400000",
"number": "1386947653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 CENTRACARE CIRCLE #2475",
"address_2": "CENTRACARE HEALTH PLAZA",
"city": "ST. CLOUD",
"state": "MN",
"postal_code": "56303",
"telephone_number": "320-229-5199",
"fax_number": "320-229-5109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1406 6TH AVENUE NORTH",
"address_2": "ST. CLOUD HOSPITAL",
"city": "ST. CLOUD",
"state": "MN",
"postal_code": "563031901",
"telephone_number": "320-251-2700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDER WEYST",
"first_name": "JESSICA",
"middle_name": "ROSE",
"credential": "PSYD, LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-08",
"last_updated": "2010-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP5304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St. Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.