Isles Therapy Center, PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3420 Issued in MN

Legal business name

ISLES THERAPY CENTER, PLLC

Practice address

615 W 35TH St
Minneapolis, MN 55408-4602

Phone

(612) 823-2063

Fax

(612) 823-8438

NPI assigned

Apr 4, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Sandra R Koch, MA, LP

Title

Licensed Psychologist

Phone

(612) 823-2063

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407978935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 W 35TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554084602",
            "telephone_number": "612-823-2063",
            "fax_number": "612-823-8438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 W 35TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554084602",
            "telephone_number": "612-823-2063",
            "fax_number": "612-823-8438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLES THERAPY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "612-823-2063",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, LP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Ishizuka, MD
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• Isles Dental PLLC
• Lyudmila Islyamova, M.D.
• Abdulaziz Ahmed Ismail
• Amal Dirie Ismail
• Amina Ismail
• Anisa Ismail

• Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.