Individual provider Active NPI

Jill Ann Marks, M.A., L.P.

  • Psychologist
  • Minneapolis, MN
National Provider Identifier
1740358985
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP3109 Issued in MN
Practice address
4317 Upton Ave S
Suite B
Minneapolis, MN 55410-1556
Phone
(612) 740-6777
Fax
(612) 824-6465
NPI assigned
Dec 4, 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
Psychologist 103T00000X LP3109 MN Primary

Addresses

Primary practice location

4317 Upton Ave S
Suite B
Minneapolis, MN 55410-1556

Mailing address

4944 Morgan Ave S
Minneapolis, MN 55419-5252
Phone (612) 823-7071

Other identifiers 2

IdentifierTypeStateIssuer
95451OtherMNHEALTH PARTNERS
38Q07MAOtherMNBLUE CROSS BLUE SHIELD

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)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
LP3109MNMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740358985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4944 MORGAN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554195252",
            "telephone_number": "612-823-7071",
            "fax_number": "612-824-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4317 UPTON AVE S",
            "address_2": "SUITE B",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554101556",
            "telephone_number": "612-740-6777",
            "fax_number": "612-824-6465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARKS",
        "first_name": "JILL",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "M.A., L.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "95451",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "38Q07MA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.