Mary Ruth Boehlke, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

MN LP0708 Issued in MN

Practice address

1660 Highway 100 S
Ste. 568
Minneapolis, MN 55416-1529

Phone

(952) 545-6800

NPI assigned

Jan 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 17, 2014 through Nov 17, 2026

Medicare enrollment (NPD)

Not enrolled

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.

• Mary R. Boehlke Psy.D. P.C.

  • Psychologist
  • St Louis Park, MN
  • NPI 1801094982
  NPD (past) Authorized official

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

{
    "created_epoch": "1137196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1609855956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17935 2ND AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554473486",
            "telephone_number": "763-476-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 HIGHWAY 100 S",
            "address_2": "STE. 568",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554161529",
            "telephone_number": "952-545-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEHLKE",
        "first_name": "MARY",
        "middle_name": "RUTH",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-14",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "MN LP0708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MN",
            "identifier": "1G186BO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara A. Bodnia, CRNA
• Megan Jan Boe, PA-C
• Brooke Boeckmann
• Enid D Boeding, MD
• Elizabeth Ann Boegeman, MSW, LICSW, LADC
• Deborah H Boehm, CNP
• Emma Jean Boerboom, RN
• Morgan Kay Boes, MD, PHD
• Nicole Boesch
• Amanda Leigh Boese, PHARMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.