Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. JADE BENDER RAFFERTY PH.D., LP
NPI 1386997179
Psychologist - Clinical Child & Adolescent in St Louis Park, MN

Q: What is Jade Rafferty's NPI number?

The NPI number for Jade Rafferty is 1386997179. It was assigned to this individual provider in the NPPES registry on October 18, 2012. The provider is also known as Dr. Jade Andromeda Bender Ph.D., LP.

Q: What is Jade Rafferty's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

Q: When was this NPI record last updated?

The NPPES record for Jade Rafferty was last updated on July 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 37 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 18, 2012

4601 EXCELSIOR BLVD STE 400, ST LOUIS PARK, MN 55416(612) 767-9860(612) 767-9861 Get Directions Write a Review

NPPES record last updated: July 3, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Dr. Jade Bender Rafferty Ph.d., Lp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JADE BENDER RAFFERTY PH.D., LP (NPI 1386997179) is an individual clinical child & adolescent provider in St Louis Park, Minnesota and active in the NPI registry since October 2012.

NPPES Registry Identity

NPI1386997179

Entity TypeIndividualFemale

Primary Taxonomy103TC2200X

Provider Legal NameDR. JADE BENDER RAFFERTYCredential: PH.D., LP

Location Address4601 EXCELSIOR BLVD STE 400St Louis Park, MN 55416-4977

Mailing Address4601 Excelsior Blvd Ste 400St Louis Park, MN 55416-4977 · (612) 767-9860 · Fax (612) 767-9861

Phone(612) 767-9860

Fax(612) 767-9861

Sole ProprietorYes

Enumeration DateOctober 18, 2012

Last NPPES UpdateJuly 3, 2026

NPPES CertifiedJuly 3, 2026

✔ NPI 1386997179 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Clinical Child & AdolescentBehavioral Health & Social Service Providers

Taxonomy Code103TC2200X

Definition

A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.

4601 EXCELSIOR BLVD STE 400, St Louis Park, MN 55416

Open in Google Maps ↗

Other Names 1

Former Name (1)Dr. Jade Andromeda Bender Ph.d., Lp

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. SUSAN REYNOLDS LICSW

Social Worker (Clinical)

4601 EXCELSIOR BLVD STE 400
ST LOUIS PARK, MN 55416

Hennepin County (952) 925-3533

MS. SALLY SIBBITT LICSW

Social Worker (Clinical)

4601 EXCELSIOR BLVD STE 400
ST LOUIS PARK, MN 55416

Hennepin County (952) 925-3533

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jade Rafferty's NPI number?

The NPI number for Jade Rafferty is 1386997179. It was assigned to this individual provider in the NPPES registry on October 18, 2012. The provider is also known as Dr. Jade Andromeda Bender Ph.D., LP.

Where is Jade Rafferty located?

Jade Rafferty practices at 4601 Excelsior Blvd Ste 400, St Louis Park, MN 55416. The listed phone number is (612) 767-9860.

What is Jade Rafferty's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

When was this NPI record last updated?

The NPPES record for Jade Rafferty was last updated on July 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 37 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.