DR. JESSICA MARYNIUK (NPI# 1396140422) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396140422 |
| Entity Type | Individual |
| Full Name | DR. JESSICA MARYNIUK |
| Other Name | JESSICA WOOD |
| Credential | PSYD |
| Practice Address |
3450 Oleary Ln Eagan MN 55123-2340 |
| Practice Telephone | 6513658213 |
| Practice Fax Number | 6514543492 |
| Mailing Telephone | 5747225151 |
| Mailing Fax Number | 6514543492 |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2019-03-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
LP6373 | MN | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1015 Michigan Ave, Logansport, IN 469471526 | 5747225151 | 5747391414 |
| Street Address |
3450 OLEARY LN |
| City | EAGAN |
| State | MN |
| Zip Code | 55123-2340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750366167 | Patrice Lauer-roberts | Social Worker | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2005-12-08 |
| 1083224232 | Saoirse Mcmahon | Social Worker | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2020-08-03 |
| 1194334318 | Lisa Joy Rutman | Social Worker | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2020-07-23 |
| 1265065114 | Kaibeh Benson | Nurse Practitioner | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2020-02-19 |
| 1952942476 | Emily J Holton | Counselor | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-10-06 |
| 1730733098 | Joshua Hampton Goodwin | Social Worker | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-07-25 |
| 1992369664 | Mary Annette Freitag | Counselor | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-04-27 |
| 1730742792 | Shannon Derfus | Counselor | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-04-16 |
| 1669930012 | Brian Nelson | Counselor | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-03-05 |
| 1891269155 | Elise Broderick Quam | Social Worker | 3450 Oleary Ln, Eagan, MN 55123 | 2019-01-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053828467 | Hilltop Family Chiropractic Center Pa | Chiropractor | 1121 Town Centre Drive Suite 202, Eagan, MN 55123 | 2018-01-08 |
| 1922452507 | Jacob Zimmerman | Counselor | 3450 O'leary Ln., Eagan, MN 55123 | 2016-04-20 |
| 1316320971 | K-squared Fitness, L.L.C. | Public Health or Welfare | 1100 Cliff Rd, Eagan, MN 55123 | 2015-07-01 |
| 1346683687 | Joshua M Dorn | Allergy & Immunology | 3460 Promenade Ave, Eagan, MN 55123 | 2013-04-16 |
| 1700172350 | Mary Christine Mcnabney | Nurse Practitioner | 610 Opperman Drive, D4 Health Center, Your Wellbeing Health Center, Eagan, MN 55123 | 2011-06-22 |
| 1033353669 | Todd Borstad | Social Worker | 3450 O'leary Lane, Eagan, MN 55123 | 2009-04-27 |
| 1821025271 | Mngi Endoscopy LLC | Clinic/Center | 1185 Town Centre Drive, Eagan, MN 55123 | 2006-06-28 |
| 1780620120 | Cindy Eileen Wood | Audiologist | 3440 Oleary Lane, 240, Eagan, MN 55123 | 2006-06-22 |
| 1609845742 | Jeffery R Dichter | Internal Medicine | 849 Govern Circle, Saint Paul, MN 55123 | 2006-03-14 |
| 1962932491 | Maliah J Mcgraw | Dentist | 1121 Town Centre Dr Ste 200, Eagan, MN 55123 | 2017-06-18 |
| Find all providers in zip 55123 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902305444 | Clifford James Buhl | Psychologist | 890 Wescott Trl Apt 201, Eagan, MN 55123-2299 | 2018-02-11 |
| 1851806855 | Solin Psychological & Consultation Services LLC | Psychologist | 4660 Slater Rd Ste 245c, Eagan, MN 55122-4047 | 2017-12-12 |
| 1720593841 | Andrea Anderson Psyd Lp LLC | Psychologist | 4660 Slater Rd Ste 245-c, Eagan, MN 55122-4047 | 2017-12-12 |
| 1912345976 | Katie Olson | Psychologist | 646 Hillside Dr, Eagan, MN 55121-2353 | 2013-06-11 |
| 1376833756 | John Timothy O'regan | Psychologist | 4159 Strawberry Ln, Eagan, MN 55123-1429 | 2011-04-19 |
| 1225195522 | Ronald Leslie Hoschouer | Psychologist | 3080 Lexington Ave S Ste 107, Eagan, MN 55121-2207 | 2007-01-03 |
| 1922196344 | Phyllis Mary Kulhanek | Psychologist | 1803 E Bluestone Dr, Eagan, MN 55122-2952 | 2006-10-11 |
| 1649378019 | Roger A. Olsen Psy.d.,l.p., LLC | Psychologist | 4660 Slater Rd, Suite 210, Eagan, MN 55122-4047 | 2006-09-20 |
| 1245712439 | Daniel Charles Rebek | Psychologist | 3460 Washington Dr Ste 200, Eagan, MN 55122-4302 | 2018-09-04 |
| 1205274990 | Annie Elizabeth Emanuel | Psychologist | 4660 Slater Rd, Suite 210, Eagan, MN 55122-4047 | 2013-06-05 |
| Find all providers in EAGAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.