Maryanne Reilly-Spong, PHD

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

LP6630 Issued in MN

Practice address

420 Delaware St SE
Ste 1460-7 Mayo
Minneapolis, MN 55455

Phone

(612) 750-1771

NPI assigned

Oct 10, 2023

Last updated

Oct 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1696896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1508647157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "STE 1460-7 MAYO, MMC 293",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-625-9946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "STE 1460-7 MAYO",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-750-1771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REILLY-SPONG",
        "first_name": "MARYANNE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-10",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP6630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Reif, MD
• Joerg Reifart, MD
• Sonja Reifsteck, DOULA
• Kristina Reigstad, M.A.
• Ronald Alexander Reilkoff, M.D.
• Barbara Reilly, RN, PHN
• Jane Elizabeth Reilly, MS LICSW
• John Reilly, LICSW
• Michael Reimann
• Thomas Gerald Reimann, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.