Active NPI
Cloquet Psychological LLC
- Clinical Psychologist
- Cloquet, MN
National Provider Identifier
1720329071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP4209
- Legal business name
- CLOQUET PSYCHOLOGICAL LLC
- Practice address
- 605 Kallstrom Rd
Cloquet, MN 55720-9415 - Phone
- (218) 940-5259
- NPI assigned
- Mar 12, 2013
- Last updated
- Mar 12, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Caroline Louise Nelson, PSYDLP
- Title
- Licensed Psychologist
- Phone
- (218) 940-5259
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP4209 | MN | Primary |
Addresses
Primary practice location
605 Kallstrom Rd
Cloquet, MN 55720-9415
Mailing address
605 Kallstrom Rd
Cloquet, MN 55720-9415
Phone (218) 940-5259
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 417629400 | Medicaid | MN | |
| 680001706 | Other | MN | MEDICARE PTAN |
National Provider Directory
National Provider Directory- Tax ID family
- Cloquet Psychological
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Cloquet, MN
- NPI 1134443393
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Clinical Psychologist
- Cloquet, MN
- NPI 1548356611
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363046400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1363046400000",
"number": "1720329071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 KALLSTROM RD",
"city": "CLOQUET",
"state": "MN",
"postal_code": "557209415",
"telephone_number": "218-940-5259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 KALLSTROM RD",
"city": "CLOQUET",
"state": "MN",
"postal_code": "557209415",
"telephone_number": "218-940-5259"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CLOQUET PSYCHOLOGICAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-03-12",
"last_updated": "2013-03-12",
"status": "A",
"authorized_official_last_name": "NELSON",
"authorized_official_first_name": "CAROLINE",
"authorized_official_middle_name": "LOUISE",
"authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
"authorized_official_telephone_number": "218-940-5259",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PSYDLP"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP4209",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "417629400",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "680001706",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cloquet, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.