Jenna Wieden, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP6503 Issued in MN

Practice address

333 Main St N Ste 110
Stillwater, MN 55082-5054

Phone

(651) 425-9297

NPI assigned

Jul 5, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Nest Professional Service Corp

  • Community/Behavioral Health Agency
  • Stillwater, MN
  • NPI 1508314071
  NPD

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

{
    "created_epoch": "1404518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1790191252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8955 JANE RD N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550429512",
            "telephone_number": "651-428-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 MAIN ST N STE 110",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550825054",
            "telephone_number": "651-425-9297"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1440 Broadway",
            "address_2": "Suite #610",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946122041",
            "country_code": "US",
            "telephone_number": "651-428-5454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIEDEN",
        "first_name": "JENNA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-05",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chad Joseph Wert, D.D.S
• Donald Walter Theisen Wessel, MD
• Kristin West, PT
• Patricia J Whitney, PT
• David Leslie Wick, D.C.
• Nancy A Wiedmeyer, LICSW
• Rachel Wieneke, MA, CCC-SLP
• Carolyn R Wiger, LADC
• Mary Elizabeth Wilkening, LICSW
• Jane Rae Wilkens, MD

• Clinical Psychologist in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; 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.