Mary Katherine Verkennes, M.A. L.P.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

LP0386 Issued in MN

Practice address

25039 East Clark Lake Road
Nisswa, MN 56468

Phone

(218) 963-2657

Fax

(218) 963-4692

NPI assigned

Jan 29, 2007

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 3

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": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1972649846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 777",
            "city": "NISSWA",
            "state": "MN",
            "postal_code": "564680777",
            "telephone_number": "218-963-2657",
            "fax_number": "218-963-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25039 EAST CLARK LAKE ROAD",
            "city": "NISSWA",
            "state": "MN",
            "postal_code": "56468",
            "telephone_number": "218-963-2657",
            "fax_number": "218-963-4692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERKENNES",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "credential": "M.A. L.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP0386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "11806VE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA AND BHP PROVIDER #",
            "identifier": "6235127",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE PROVIDER ID",
            "identifier": "126422",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Stenger, COTA/L
• Aron Michael Stumvoll, DC
• Lisa Marie Swenson, RDCS
• The Evangelical Lutheran Good Samaritan Society
• The Evangelical Lutheran Good Samaritan Society
• Luke E. Waln, DDS
• Wellnessone of Nisswa
• Wellspring Behavioral Health

• Counseling Psychologist in Nisswa, MN
• Providers in Nisswa, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.