| Jacquelyn K. Wiersma, Ph. D., Lp, Pllc | |
|
3931 Auburn Dr Minnetonka MN 55305-5196 | |
| (952) 938-9499 | |
| (952) 938-9499 |
| Full Name | Jacquelyn K. Wiersma, Ph. D., Lp, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 3931 Auburn Dr, Minnetonka, Minnesota |
| Authorized Official Name and Position | Jacquelyn K. Wiersma (CHIEF MANAGER) |
| Authorized Official Contact | 9529389499 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacquelyn K. Wiersma, Ph. D., Lp, Pllc 3931 Auburn Dr Minnetonka MN 55305-5196 Ph: (952) 938-9499 | Jacquelyn K. Wiersma, Ph. D., Lp, Pllc 3931 Auburn Dr Minnetonka MN 55305-5196 Ph: (952) 938-9499 |
| NPI Number | 1770696726 |
|---|---|
| Provider Enumeration Date | 08/16/2006 |
| Last Update Date | 04/05/2017 |
| Medicare PECOS PAC ID | 3274534391 |
|---|---|
| Medicare Enrollment ID | O20070116000335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770696726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP1583 (Minnesota) | Primary |
| Provider Name | Jacquelyn K Wiersma |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386757300 PECOS PAC ID: 3173562519 Enrollment ID: I20050426000891 |
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