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NPI Code Detail

MEDICARE: DR. EMILY ROSE VAN WYK PSY.D., LP

MEDICARE: DR. EMILY ROSE VAN WYK PSY.D., LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistLP5747MN

General Provider Information

NPI Number : 1174939961
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EMILY ROSE VAN WYK PSY.D., LP
Provider Business Mailing Address
First Line : 621 W LAKE ST STE 350
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2952
Country : US
Telephone Number : 612-979-2276
Fax Number : 651-925-0427
Provider Business Practice Location Address
First Line : 621 W LAKE ST STE 350
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2952
Country : US
Telephone Number : 612-979-2276
Fax Number : 651-925-0427
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2014
Last Update Date : 01/30/2026

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