Active NPI
Mary K Vanreken, PHD
- Psychologist
- Bloomington, MN
National Provider Identifier
1609891639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP 3060
- Practice address
- 7800 Metro Pkwy Ste 300
Bloomington, MN 55425-1509 - Phone
- (952) 854-4116
- Fax
- (952) 854-4199
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP 3060 | MN | Primary |
Addresses
Primary practice location
7800 Metro Pkwy Ste 300
Bloomington, MN 55425-1509
Mailing address
7800 Metro Pkwy Ste 300
Bloomington, MN 55425-1509
Phone (952) 854-4116
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142661 | Other | FM | UCARE-MN |
| 64G50VA | Other | MN | BCBSMN |
| 337731 | Other | MN | VALUE OPTIONS |
| 61-52099 | Other | FM | UBH |
| 7201179 | Other | MN | AETNA |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP 3060 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1609891639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7800 METRO PKWY STE 300",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554251509",
"telephone_number": "952-854-4116",
"fax_number": "952-854-4199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7800 METRO PKWY STE 300",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554251509",
"telephone_number": "952-854-4116",
"fax_number": "952-854-4199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANREKEN",
"first_name": "MARY",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP 3060",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE-MN",
"identifier": "142661",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSMN",
"identifier": "64G50VA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "337731",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "61-52099",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7201179",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.