Individual provider Active NPI

Jael Jaffe-Talberg, PSY.D.

  • Psychologist
  • Bloomington, MN
National Provider Identifier
1952751240
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP6210 Issued in MN
Practice address
1801 American Blvd E Ste 1
Bloomington, MN 55425-1230
Phone
(952) 767-2267
NPI assigned
Jun 16, 2016
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY0004429 CO
Psychologist 103T00000X LP6210 MN Primary

Addresses

Primary practice location

1801 American Blvd E Ste 1
Bloomington, MN 55425-1230

Mailing address

1801 American Blvd E Ste 1
Bloomington, MN 55425-1230
Phone (952) 767-2267

Other practice location 1

8931 Huron St
Thornton, CO 80260-6806
Phone (303) 853-3500

Other practice location 2

16180 Hastings Ave SE Ste 205
Prior Lake, MN 55372-9228
Phone (952) 443-4600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180228001351 MN Practitioner - Clinical Psychologist 5294021374 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY0004429COMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fraser Child and Family Center CurrentSince May 27, 2021 Accepting new patients
Fraser Past Accepting new patients

Locations

1801 American Blvd E
Ste 8
Minneapolis, MN 55425
Phone (612) 400-6173

9120 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 231-2590

2400 W 64th St
Richfield, MN 55423
Phone (612) 767-5166

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1952751240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 AMERICAN BLVD E STE 1",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251230",
            "telephone_number": "952-767-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 AMERICAN BLVD E STE 1",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251230",
            "telephone_number": "952-767-2267"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8931 Huron St",
            "address_purpose": "LOCATION",
            "city": "Thornton",
            "state": "CO",
            "postal_code": "802606806",
            "country_code": "US",
            "telephone_number": "303-853-3500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16180 Hastings Ave SE Ste 205",
            "address_purpose": "LOCATION",
            "city": "Prior Lake",
            "state": "MN",
            "postal_code": "553729228",
            "country_code": "US",
            "telephone_number": "952-443-4600",
            "fax_number": "952-443-4604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAFFE-TALBERG",
        "first_name": "JAEL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-16",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "PSY0004429",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP6210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.