| Eagan Psychotherapy Llc | |
|
3464 Washington Dr Ste 115 Eagan MN 55122-1453 | |
| (651) 348-8551 | |
| (651) 409-2029 |
| Full Name | Eagan Psychotherapy Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3464 Washington Dr Ste 115, Eagan, Minnesota |
| Authorized Official Name and Position | Mackenzie Kerber (PSYCHOTHERAPIST) |
| Authorized Official Contact | 6513488551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagan Psychotherapy Llc 3464 Washington Dr Ste 115 Eagan MN 55122-1453 Ph: (651) 348-8551 | Eagan Psychotherapy Llc 3464 Washington Dr Ste 115 Eagan MN 55122-1453 Ph: (651) 348-8551 |
| NPI Number | 1518501584 |
|---|---|
| Provider Enumeration Date | 11/03/2019 |
| Last Update Date | 09/12/2025 |
| Certification Date | 09/12/2025 |
| Medicare PECOS PAC ID | 7012313976 |
|---|---|
| Medicare Enrollment ID | O20210901002573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518501584 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Andrea R Overall Rick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235360652 PECOS PAC ID: 8426282666 Enrollment ID: I20131002000099 |
| Provider Name | Cynthia Jane Markison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881737187 PECOS PAC ID: 1355749482 Enrollment ID: I20211004003319 |
| Provider Name | Jenna Butzow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063751998 PECOS PAC ID: 1951709500 Enrollment ID: I20211012001495 |
| Provider Name | Katherine Lynn Desannoy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538792700 PECOS PAC ID: 0345635751 Enrollment ID: I20220322002523 |
| Provider Name | Jessica Speltz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124760756 PECOS PAC ID: 3476934563 Enrollment ID: I20220720003534 |
| Provider Name | Maia Shanae Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194311043 PECOS PAC ID: 3375905599 Enrollment ID: I20230818002368 |
| Provider Name | Samantha R Franklin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1841725009 PECOS PAC ID: 2567868425 Enrollment ID: I20240904000273 |
| Provider Name | Mackenzie Lea Kerber |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831541168 PECOS PAC ID: 0749686608 Enrollment ID: I20240912000955 |
| Provider Name | Alexandria Robison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699558676 PECOS PAC ID: 6507399847 Enrollment ID: I20241025000395 |
| Provider Name | Sorina Noelle Locklin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1912729674 PECOS PAC ID: 2466978531 Enrollment ID: I20250501001595 |
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