Jacqueline Ann Moeller, PSYD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4901 Issued in MN

Practice address

3915 Golden Valley Rd
Courage Center
Golden Valley, MN 55422-4249

Phone

(763) 520-0344

Fax

(763) 520-0216

NPI assigned

Jan 31, 2008

Last updated

Jan 31, 2008By the provider in NPPES

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 names 1

• Jacqueline Ann Hinchliff Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201737600000",
    "number": "1861670960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3915 GOLDEN VALLEY RD",
            "address_2": "COURAGE CENTER",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224249",
            "telephone_number": "763-520-0344",
            "fax_number": "763-520-0216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3915 GOLDEN VALLEY RD",
            "address_2": "COURAGE CENTER",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224249",
            "telephone_number": "763-520-0344",
            "fax_number": "763-520-0216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOELLER",
        "first_name": "JACQUELINE",
        "middle_name": "ANN",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-31",
        "last_updated": "2008-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "HINCHLIFF",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Minnesota Medical Services PLLC
• Filipa Miranda Dos Santos, DDS
• Sanjay K Mishra, MD
• Mitchell Senior Services LLC (Synergy HomeCare of Golden Valley)
• Lori Ann Mitchell, LICSW
• Nelly Mogeni
• Wafaa Hassan Mohamed
• Anab Said Mohamud
• Layla Muse Mohamud
• Moments Palliative Care LLC

• Clinical Psychologist in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.