Tracey Shoemaker, MA, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3750 Issued in MN

Practice address

1485 81St Ave NE
Spring Lake Park, MN 55432-2111

Phone

(763) 780-3036

NPI assigned

Sep 15, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902902323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 HOLIDAY RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553455417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 81ST AVE NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322111",
            "telephone_number": "763-780-3036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOEMAKER",
        "first_name": "TRACEY",
        "credential": "MA, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "62-22415",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA",
            "identifier": "5483166-00",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "61D95SH",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP27880",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "108248",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Spring Lake Park, MN
• Providers in Spring Lake Park, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.