Mary R. Boehlke Psy.D. P.C.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

MN LP0708 Issued in MN

Legal business name

MARY R. BOEHLKE PSY.D. P.C.

Practice address

1660 Highway 100 S
Ste. 568
St Louis Park, MN 55416-1529

Phone

(952) 545-6800

NPI assigned

Jul 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mary Boehlke, PSY.D.NPI 1609855956

Title

President

Phone

(952) 545-6800

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Ruth Boehlke, PSY.D.

  • Psychologist
  • Minneapolis, MN
  • NPI 1609855956
  NPD (past) Authorized official

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1801094982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17935 2ND AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554473486",
            "telephone_number": "763-476-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 HIGHWAY 100 S",
            "address_2": "STE. 568",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161529",
            "telephone_number": "952-545-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY R. BOEHLKE PSY.D. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "BOEHLKE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-545-6800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "MN LP0708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MN",
            "identifier": "1G182BO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coral M Martin
• Natalie Boe Martin
• Morgan Rae Martincek
• Courtney Alexis Martindale
• Elizabeth Marie Marx, MA, LMFT
• Mason Moore Consultants
• Deborah Mason-Moore, M.S.
• Lura L Mason, DPT
• Christina Ann Massari, PSY.D.
• Jordyn Louise Massop, PA-C

• Psychologist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.