Active NPI
Rebecca Rowena Sullivan Bertram, PSYD,, LP
- Counseling Psychologist
- Plymouth, MN
National Provider Identifier
1710358387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- LP5934
- Practice address
- 9800 Rockford Rd
Plymouth, MN 55442-2811 - Phone
- (952) 460-9008
- Fax
- (763) 416-0916
- NPI assigned
- Oct 8, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | LP5934 | MN | Primary |
Addresses
Primary practice location
9800 Rockford Rd
Plymouth, MN 55442-2811
Mailing address
9800 Rockford Rd
Plymouth, MN 55442-2811
Phone (952) 460-9008
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444262400000",
"number": "1710358387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9800 ROCKFORD RD",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554422811",
"telephone_number": "952-460-9008",
"fax_number": "763-416-0916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9800 ROCKFORD RD",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554422811",
"telephone_number": "952-460-9008",
"fax_number": "763-416-0916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTRAM",
"first_name": "REBECCA",
"middle_name": "ROWENA SULLIVAN",
"name_prefix": "Dr.",
"credential": "PSYD,, LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-08",
"last_updated": "2015-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MN",
"license": "LP5934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.