Kerry Lynn Van Dusen, PSYD LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4115 Issued in MN

Practice address

324 W Superior St
Suite 400
Duluth, MN 55802

Phone

(218) 740-3026

Fax

(218) 740-3030

NPI assigned

Mar 14, 2007

Last updated

Dec 30, 2021By the provider in NPPES

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 3

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

Specialty

Clinical Psychologist

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carver County

  dba Carver County Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waconia, MN
  • NPI 1326049685
  NPD (past)

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1700919073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 W SUPERIOR ST",
            "address_2": "SUITE 400",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55802",
            "telephone_number": "218-740-3026",
            "fax_number": "218-740-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 W SUPERIOR ST",
            "address_2": "SUITE 400",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55802",
            "telephone_number": "218-740-3026",
            "fax_number": "218-740-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DUSEN",
        "first_name": "KERRY",
        "middle_name": "LYNN",
        "credential": "PSYD LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "174M6N0",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "705222700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "174M7VA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justine Urshan, RN, CNP
• Molly Jane Vail-Jackson, MD
• Sharnell Rae Valentine, MD
• Richard J Valento, LPCC
• Michelle Turner Vallie, PA-C
• Jacquelyn Ann Van Ert
• Ellie Van Gilder, PA-C
• Erin Jane Van Hon, RD/LD
• Jared Van Hooser
• Amy Van Loon, PHARMD

• Clinical Psychologist in Duluth, MN
• Providers in Duluth, 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 30, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.