Individual provider Active NPI

Andrea Renee Zuellig, PH.D., LP

  • Clinical Psychologist
  • Burnsville, MN
National Provider Identifier
1679551527
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP4490 Issued in MN
Practice address
14569 Grand Ave
Burnsville, MN 55306-5729
Phone
(952) 898-5020
Fax
(952) 898-5858
NPI assigned
Jan 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP4490 MN Primary

Addresses

Primary practice location

14569 Grand Ave
Burnsville, MN 55306-5729

Mailing address

7952 Timber Lake Dr
Eden Prairie, MN 55347-1137

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040223001065 MN Practitioner - Clinical Psychologist 8921994468 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

3525 Monterey Dr
St Louis Park, MN 55416-5275
Phone (952) 993-1990

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
LP4490MNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Mar 2, 2009 Accepting new patients
Park Nicollet Clinic CurrentSince Mar 2, 2009 Accepting new patients
Bushman Psychological Services LLC PastSince Jul 17, 2015 Accepting new patients

Locations

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1136073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679551527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7952 TIMBER LAKE DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553471137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14569 GRAND AVE",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553065729",
            "telephone_number": "952-898-5020",
            "fax_number": "952-898-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZUELLIG",
        "first_name": "ANDREA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "PH.D., LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.