Rowan P Buckley, PSYD
Individual provider Active NPI Clinical Psychologist · Loretto, MN
NPI 1992145288 · NPPES record last updated Jul 9, 2020
Key facts
- NPI
- 1992145288
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 5599 (MN)
- Practice address
- 6825 Owen St Ste 201
Loretto, MN 55357-9713 - Phone
- (612) 916-1147
- NPI assigned
- Jul 1, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
- Opted out of Medicare
- Yes, effective May 15, 2016 through May 15, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5599 | MN | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 5599 | MN | |
| Family Psychologist | 103TF0000X | 5599 | MN | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 5599 | MN | |
| Rehabilitation Psychologist | 103TR0400X | 5599 | MN | |
| Clinical Psychologist | 103TC0700X | 5599 | MN | Yes |
| Cognitive & Behavioral Psychologist | 103TB0200X | 5599 | MN |
Addresses
Primary practice location
6825 Owen St Ste 201
Loretto, MN 55357-9713
Mailing address
6825 Owen St Ste 201
Loretto, MN 55357-9713
Phone (612) 916-1147
Other providers in Loretto, MN
- Gabriel Storm Becker-Finn
- Mark Thomas Collins
- Megan Grunerud
- Angie Hyde
- Brian William Kolling
- Ricki Gene Krueger
All providers in Loretto, MN · Clinical Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.