Heather Joy Roark, PSY D, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP5089 Issued in MN

Practice address

624 13TH St S
Virginia, MN 55792-3149

Phone

(218) 749-2881

Fax

(218) 749-3806

NPI assigned

Nov 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Heather Joy Stanaway Former name

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Range Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Virginia, MN
  • NPI 1457452823
  Medicare reassignment NPD
• Range Mental Health Center Inc

  dba Wellstone Center for Recovery

  • Mental Illness Community Based Residential Treatment Facility
  • Virginia, MN
  • NPI 1770872491
  NPD (past)

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417996800000",
    "number": "1619048980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1188",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557921188",
            "telephone_number": "218-749-2881",
            "fax_number": "218-749-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 13TH ST S",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557923149",
            "telephone_number": "218-749-2881",
            "fax_number": "218-749-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROARK",
        "first_name": "HEATHER",
        "middle_name": "JOY",
        "name_prefix": "Mrs.",
        "credential": "PSY D, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-10",
        "last_updated": "2014-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP5089",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "STANAWAY",
            "middle_name": "JOY",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily A Reed, APRN,CNP
• Angela Rene Renner, D.C.
• Alissa M Richards
• Kevin P Riess, MD
• Jakob David Rikkola, PT
• Lois Ann Robillard, PT
• Rock Ridge Public Schools
• Sara D Rohr, MSW, LICSW
• Tara Kaye Romsaas, SLP
• Hannah Preanka Rosendahl, PHARMD

• Clinical Psychologist in Virginia, MN
• Providers in Virginia, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.