Individual provider Active NPI

Linda Wondrasch

  • Clinical Psychologist
  • St Louis Park, MN
National Provider Identifier
1396722211
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP4415 Issued in MN
Practice address
6490 Excelsior Blvd
Ste W505
St Louis Park, MN 55426-4705
Phone
(952) 993-6200
NPI assigned
Dec 30, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP4415 MN Primary

Addresses

Primary practice location

6490 Excelsior Blvd
Ste W505
St Louis Park, MN 55426-4705

Mailing address

6465 Wayzata Blvd
Ste 315
Minneapolis, MN 55426-1728

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040102000319 MN Practitioner - Clinical Psychologist 4284533852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

3525 Monterey Dr
St Louis Park, MN 55416-5275
Phone (952) 993-1990

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Jul 19, 2015 Accepting new patients
Park Nicollet Clinic CurrentSince Jul 19, 2015 Accepting new patients
Park Nicollet Clinic Current Accepting new patients

Locations

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

6490 Excelsior Blvd
Ste W505
St Louis Park, MN 55426

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1396722211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "STE 315",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554261728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6490 EXCELSIOR BLVD",
            "address_2": "STE W505",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264705",
            "telephone_number": "952-993-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONDRASCH",
        "first_name": "LINDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-30",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.