Active NPI
Charlotte Mae Gerth Haanen, PHD, LP
- Clinical Psychologist
- Burnsville, MN
National Provider Identifier
1841899291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP4832
- Practice address
- 2805 Cliff Rd E
Burnsville, MN 55337-4095 - Phone
- (612) 203-9156
- NPI assigned
- Oct 17, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP4832 | MN | Primary |
Addresses
Primary practice location
2805 Cliff Rd E
Burnsville, MN 55337-4095
Mailing address
1671 Canyon LN
New Brighton, MN 55112-7240
Phone (612) 203-9156
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP4832 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602892800000",
"number": "1841899291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1671 CANYON LN",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "551127240",
"telephone_number": "612-203-9156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 CLIFF RD E",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553374095",
"telephone_number": "612-203-9156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERTH HAANEN",
"first_name": "CHARLOTTE",
"middle_name": "MAE",
"credential": "PHD, LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-17",
"last_updated": "2020-10-17",
"certification_date": "2020-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP4832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.