Anthony Odland, PHD, LP, ABPP

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

LP5884 Issued in MN

Practice address

15600 36TH Ave N Ste 140
Plymouth, MN 55446-3372

Phone

(763) 308-5772

Fax

(612) 392-7974

NPI assigned

Jun 11, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Credentials

Doctor of Philosophy

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.

• Neuro PLLC

  • Clinical Neuropsychologist
  • Plymouth, MN
  • NPI 1003542069
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660348800000",
    "number": "1669853099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15600 36TH AVE N STE 140",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463372",
            "telephone_number": "763-308-5772",
            "fax_number": "612-392-7974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15600 36TH AVE N STE 140",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463372",
            "telephone_number": "763-308-5772",
            "fax_number": "612-392-7974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODLAND",
        "first_name": "ANTHONY",
        "credential": "PHD, LP, ABPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-11",
        "last_updated": "2022-08-13",
        "certification_date": "2022-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MN",
            "license": "LP5884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark O'Brien
• Jacob Clay O'Neal
• Sophie O'Rourke
• Oceanview Management Inc
• Megan Ocken Helmen, PSY.D.
• Nima Ibrahim Odowa, DDS
• Brian Jessy Oduguwa, MSW, LICSW
• Karen Ann Oelschlaeger, PT
• Stacey Marie Ohumukini, OTR/L
• Mark K Okeefe

• Clinical Neuropsychologist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Clinical Neuropsychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2022; 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.