Jeanette Laverne Vought, PHD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3556 Issued in MN

Practice address

13911 Ridgedale Dr Ste 460
Minnetonka, MN 55305-1777

Phone

(651) 439-2059

Fax

(888) 675-8262

NPI assigned

Jun 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Rush IncGroup PAC ID 8224131750, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Rush Inc

  • Psychologist
  • Stillwater, MN
  • NPI 1801942040
  Medicare reassignment Care Compare group NPD
• Christian Recovery Center

  • Psychologist
  • Golden Valley, MN
  • NPI 1003879164
  NPD (past)
• Christian Recovery Center

  • Counselor
  • Brooklyn Center, MN
  • NPI 1831213420
  NPD (past)

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1821034786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "588 101ST AVE N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341083201",
            "telephone_number": "651-439-2059",
            "fax_number": "888-675-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13911 RIDGEDALE DR STE 460",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051777",
            "telephone_number": "651-439-2059",
            "fax_number": "888-675-8262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6120 Earle Brown Dr",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Brooklyn Center",
            "state": "MN",
            "postal_code": "554302123",
            "country_code": "US",
            "telephone_number": "763-566-0088",
            "fax_number": "763-566-0089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VOUGHT",
        "first_name": "JEANETTE",
        "middle_name": "LAVERNE",
        "name_prefix": "Mrs.",
        "credential": "PHD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821034786",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Volunteers of America Assisted Living Communities
• Volunteers of America Home Health Services
• Volunteers of America MN
• Julia Vongphachanh
• Barry Voroba, PH.D.
• Kelly Vourlos, MSW, LICSW
• Matthew Vradenburg, DC
• Carmen Lynn Vriezema, AC/ AGPCNP-BC
• Sarah Marie Waech
• William Walton Wagnild, DDS

• Psychologist in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.