Tressa Kay Reisetter, PHD, LP, NCSP

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

LP4752 Issued in MN

Practice address

621 Red Oak Dr
Big Lake, MN 55309-9585

Phone

(612) 597-2737

NPI assigned

Feb 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2025 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Choices Psychotherapy, LTD.

  • Professional Counselor
  • Minnetonka, MN
  • NPI 1134171127
  NPD (past)
• Ames Psychological Wellness Center, PLC

  • Counseling Psychologist
  • Ames, IA
  • NPI 1861931131
  NPD (past)

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1467597567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 RED OAK DR",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553099585",
            "telephone_number": "612-597-2737",
            "fax_number": "763-566-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 RED OAK DR",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553099585",
            "telephone_number": "612-597-2737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REISETTER",
        "first_name": "TRESSA",
        "middle_name": "KAY",
        "credential": "PHD, LP, NCSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2019014342",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MN",
            "license": "LP4752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14450911",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Psychological Assessment Services
• Marissa Ragusin
• Jagannathan Ramakrishnan, DDS
• Ramps R US
• Reed D. Dill, D.D.S. P.a.
• Janice C Reker
• Thomas Brice Ritchie, BALADC
• Brad Roesler, RPH
• Sarah Rowe, PT, DPT
• Kelly Ann Salzl, MS, LMFT

• Clinical Neuropsychologist in Big Lake, MN
• Providers in Big Lake, MN by specialty
• Clinical Neuropsychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.