Individual provider Active NPI

Jane Rollwagen King, PSYD

  • Clinical Psychologist
  • Saint Paul, MN
National Provider Identifier
1558552323
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP4833 Issued in MN
Practice address
400 Sibley St
Saint Paul, MN 55101-1941
Phone
(651) 256-1204
Fax
(651) 291-7378
NPI assigned
Aug 7, 2007
Last updated
Nov 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP4833 MN Primary

Addresses

Primary practice location

400 Sibley St
Saint Paul, MN 55101-1941

Mailing address

400 Sibley St
Saint Paul, MN 55101-1941
Phone (651) 256-1204

Other practice location 1

2120 Park Ave
Minneapolis, MN 55404-3378
Phone (651) 774-0011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080501000513 MN Practitioner - Clinical Psychologist 4789763772 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
People Incorporated Current Accepting new patients
People Incorporated CurrentSince Nov 3, 2025 Accepting new patients

Locations

1930 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 427-7964

2120 Park Ave
Minneapolis, MN 55404
Phone (612) 872-2000

5555 Boone Ave N
New Hope, MN 55428
Phone (763) 331-3033

3000 Ames Crossing Rd
Ste 600
Saint Paul, MN 55121
Phone (651) 288-3467

317 York Ave
Saint Paul, MN 55130
Phone (651) 771-0286

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763510400000",
    "number": "1558552323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SIBLEY ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551011941",
            "telephone_number": "651-256-1204",
            "fax_number": "651-291-7378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SIBLEY ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551011941",
            "telephone_number": "651-256-1204",
            "fax_number": "651-291-7378"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2120 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554043378",
            "country_code": "US",
            "telephone_number": "651-774-0011",
            "fax_number": "651-774-0606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "JANE",
        "middle_name": "ROLLWAGEN",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-07",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.