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

RANDALL R POTTEBAUM
NPI 1528042223
Psychologist in Burnsville, MN

Active since December 06, 2005
14000 FAIRVIEW DR, PARK NICOLLET CLINIC BURNSVILLE, BURNSVILLE, MN 55337(952) 993-8608 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Randall R Pottebaum NPPES

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

RANDALL R POTTEBAUM (NPI 1528042223) is an individual psychologist in Burnsville, Minnesota, licensed in Minnesota (55) and active in the NPI registry since December 2005.

NPPES Registry Identity

NPI1528042223
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameRANDALL R POTTEBAUM
Location Address14000 FAIRVIEW DR, PARK NICOLLET CLINIC BURNSVILLEBurnsville, MN 55337-5713
Mailing Address6465 Wayzata Blvd, Ste 315St Louis Park, MN 55426-1728 · (952) 993-6450 · Fax (952) 993-0300
Sole ProprietorNo
Enumeration DateDecember 6, 2005
Last NPPES UpdateJuly 13, 2026
NPI 1528042223 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in MN · 55
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
14000 FAIRVIEW DR, Burnsville, MN 55337

Other Providers at the Same Location NPPES 20

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

Physical Therapist
14000 FAIRVIEW DR
BURNSVILLE, MN 55337
Physician Assistant
14000 FAIRVIEW DR
BURNSVILLE, MN 55337
Obstetrics & Gynecology
14000 FAIRVIEW DR
BURNSVILLE, MN 55337
Family Medicine
14000 FAIRVIEW DR
BURNSVILLE, MN 55337
Physician Assistant
14000 FAIRVIEW DR
BURNSVILLE, MN 55337
Internal Medicine
14000 FAIRVIEW DR
BURNSVILLE, MN 55337
Nurse Practitioner (Gerontology)
14000 FAIRVIEW DR
BURNSVILLE, MN 55337
Pediatrics
14000 FAIRVIEW DR
BURNSVILLE, MN 55337

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 Randall Pottebaum's NPI number?

The NPI number for Randall Pottebaum is 1528042223. It was assigned to this individual provider in the NPPES registry on December 6, 2005.

Where is Randall Pottebaum located?

Randall Pottebaum practices at 14000 Fairview Dr Park Nicollet Clinic Burnsville, Burnsville, MN 55337. The listed phone number is (952) 993-8608.

What is Randall Pottebaum's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

When was this NPI record last updated?

The NPPES record for Randall Pottebaum was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 27 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.