Active NPI
Kathleen Marie Wise, M.A., L.P.
- Psychologist
- New Hope, MN
National Provider Identifier
1871581017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP3227
- Practice address
- 7600 Bass Lake Rd
Suite 106
New Hope, MN 55428-3860 - Phone
- (612) 865-9143
- NPI assigned
- Oct 12, 2005
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP3227 | MN | Primary |
Addresses
Primary practice location
7600 Bass Lake Rd
Suite 106
New Hope, MN 55428-3860
Mailing address
205 Lily Pond Cir
Loretto, MN 55357-9654
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500526400 | Medicaid | MN |
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)
- Enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279238400000",
"number": "1871581017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 LILY POND CIR",
"city": "LORETTO",
"state": "MN",
"postal_code": "553579654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7600 BASS LAKE RD",
"address_2": "SUITE 106",
"city": "NEW HOPE",
"state": "MN",
"postal_code": "554283860",
"telephone_number": "612-865-9143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "KATHLEEN",
"middle_name": "MARIE",
"credential": "M.A., L.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-10-12",
"last_updated": "2010-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP3227",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500526400",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Hope, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.