Active NPI
Benjamin Kenneth Jurek, PSY.D, LP
- Clinical Psychologist
- St. Cloud, MN
National Provider Identifier
1568616019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5215
- Practice address
- 4801 Vetrans Drive
St. Cloud, MN 56303 - Phone
- (320) 252-1670
- NPI assigned
- Nov 11, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5215 | MN | Primary |
Addresses
Primary practice location
4801 Vetrans Drive
St. Cloud, MN 56303
Mailing address
4801 Vetrans Drive
St. Cloud, MN 56303
Phone (320) 252-1670
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65Q84VE | Other | MN | VA MEDICAL CENTER |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5215 | MN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269561600000",
"number": "1568616019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4801 VETRANS DRIVE",
"city": "ST. CLOUD",
"state": "MN",
"postal_code": "56303",
"telephone_number": "320-252-1670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 VETRANS DRIVE",
"city": "ST. CLOUD",
"state": "MN",
"postal_code": "56303",
"telephone_number": "320-252-1670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUREK",
"first_name": "BENJAMIN",
"middle_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "PSY.D, LP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-11",
"last_updated": "2010-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "5215",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA MEDICAL CENTER",
"identifier": "65Q84VE",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St. Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.