Active NPI
Pennie Deann Rubbelke, LGSW
- Mental Health Counselor
- Baxter, MN
National Provider Identifier
1427760701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 27062
- Practice address
- 13782 Bluestem CT Ste 100
Baxter, MN 56425-8768 - Phone
- (218) 833-9107
- NPI assigned
- Dec 19, 2022
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 27062 | MN | Primary |
Addresses
Primary practice location
13782 Bluestem CT Ste 100
Baxter, MN 56425-8768
Mailing address
13782 Bluestem CT Ste 100
Baxter, MN 56425-8768
Phone (218) 833-9107
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nystrom & Associates, LTD | 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.
-
- Clinical Social Worker
- New Brighton, MN
- NPI 1396750188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1671408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671408000000",
"number": "1427760701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13782 BLUESTEM CT STE 100",
"city": "BAXTER",
"state": "MN",
"postal_code": "564258768",
"telephone_number": "218-833-9107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13782 BLUESTEM CT STE 100",
"city": "BAXTER",
"state": "MN",
"postal_code": "564258768",
"telephone_number": "218-833-9107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUBBELKE",
"first_name": "PENNIE",
"middle_name": "DEANN",
"credential": "LGSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-19",
"last_updated": "2022-12-19",
"certification_date": "2022-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "27062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baxter, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.