The Compassion Boutique PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

THE COMPASSION BOUTIQUE PC

Doing business as

The Compassion Boutique

Practice address

4500 Park Glen Rd Ste 450
St Louis Park, MN 55416-5190

Phone

(952) 259-9099

NPI assigned

Nov 9, 2024

Last updated

Nov 9, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Elizabeth Wagner, PSYDNPI 1922128529

Title

Ceo

Phone

(952) 295-9099

Specialties & licenses 3

Addresses

Other names 1

• The Compassion Boutique Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elizabeth Wagner, PSYD

  • Clinical Psychologist
  • St Louis Park, MN
  • NPI 1922128529
  NPD Authorized official

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

{
    "created_epoch": "1731110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731110400000",
    "number": "1457175267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 PARK GLEN RD STE 450",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165190",
            "telephone_number": "952-259-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 PARK GLEN RD STE 450",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165190",
            "telephone_number": "952-259-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COMPASSION BOUTIQUE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-09",
        "last_updated": "2024-11-09",
        "certification_date": "2024-11-09",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-295-9099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Compassion Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Psychologist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2024; 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.