Active NPI
Jennifer Lynn Joseph, PSY.D., LP
- Cognitive & Behavioral Psychologist
- Minneapolis, MN
National Provider Identifier
1417035551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- 4669
- Practice address
- 3001 Broadway St NE
Suite 185
Minneapolis, MN 55413-2195 - Phone
- (612) 767-4224
- NPI assigned
- Nov 2, 2006
- 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 |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 4669 | MN | Primary |
Addresses
Primary practice location
3001 Broadway St NE
Suite 185
Minneapolis, MN 55413-2195
Mailing address
5762 213TH St N
Forest Lake, MN 55025-9589
Phone (651) 982-4903
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 637K9SH | Other | MN | BCBS |
| HP66846 | Other | MN | HEALTH PARTNERS |
Other names 1
- Dr. Jennifer Lynn Shandley
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4669 | MN | MD | Cognitive & Behavioral Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Natalis Counseling and Psychology Solutions, P.a. | 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.
-
- Psychologist
- Saint Paul, MN
- NPI 1447369673
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417035551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5762 213TH ST N",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550259589",
"telephone_number": "651-982-4903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 BROADWAY ST NE",
"address_2": "SUITE 185",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554132195",
"telephone_number": "612-767-4224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOSEPH",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PSY.D., LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MN",
"license": "4669",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "637K9SH",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP66846",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "SHANDLEY",
"middle_name": "LYNN",
"prefix": "DR.",
"credential": "PSY.D., LP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Minneapolis, 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.