Ksa Psychological Services, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4687 Issued in MN

Legal business name

KSA PSYCHOLOGICAL SERVICES, LLC

Practice address

5603 Chicago Ave.
Minneapolis, MN 55417

Phone

(612) 298-9587

NPI assigned

Feb 15, 2018

Organization subpart

No

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

Authorized official

Name

Angela Scott, LPNPI 1386696110

Title

Co-Owner/Manager

Phone

(612) 298-9587

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

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

• Angela Scott, LP

  • Counseling Psychologist
  • Saint Paul, MN
  • NPI 1386696110
  Medicare reassignment Care Compare group NPD Authorized official
• Kathryn Marie Christensen, L.P.

  • Clinical Psychologist
  • Edina, MN
  • NPI 1790867315
  Medicare reassignment Care Compare group NPD
• Shannon O'Donnell, L.P.

  • Clinical Psychologist
  • Saint Paul, MN
  • NPI 1053483453
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1518652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518652800000",
    "number": "1902306038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 BROMPTON PLACE",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "55118",
            "telephone_number": "612-998-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5603 CHICAGO AVE.",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55417",
            "telephone_number": "612-298-9587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSA PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-15",
        "last_updated": "2018-02-15",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CO-OWNER/MANAGER",
        "authorized_official_telephone_number": "612-298-9587",
        "authorized_official_credential": "LP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4687",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4679",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4436",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Krysiak
• Michael Peter Krysiak, O.D.
• Steven Wenzel Kryzer
• Jennifer Ann Tam Krzmarzick, MD
• Cathie L Krzywon
• Vibhu R Kshettry, MD
• KTJ 292, LLC
• Christina Ku, PHARMD
• Mary Kuan
• Tina M Kubat, CRNA

• Clinical Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.