JACQUELYN K. WIERSMA, PH. D., LP, PLLC
NPI 1770696726
Psychologist - Clinical in Minnetonka, MN

Q: What is Jacquelyn K. Wiersma, Ph. D., LP, PLLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since August 16, 2006

3931 AUBURN DR, MINNETONKA, MN 55305(952) 938-9499(952) 938-9499 Get Directions Write a Review

NPPES record last updated: April 5, 2017. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Jacquelyn K. Wiersma, Ph. D., Lp, Pllc NPPES

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

JACQUELYN K. WIERSMA, PH. D., LP, PLLC (NPI 1770696726) is a healthcare organization registered as a clinical in Minnetonka, Minnesota and active in the NPI registry since August 2006. The organization lists Jacquelyn K. Wiersma, Chief Manager, as its authorized official.

NPPES Registry Identity

NPI1770696726

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NameJACQUELYN K. WIERSMA, PH. D., LP, PLLC

Location Address3931 AUBURN DRMinnetonka, MN 55305-5196

Mailing Address3931 Auburn DrMinnetonka, MN 55305-5196 · (952) 938-9499 · Fax (952) 938-9499

Phone(952) 938-9499

Fax(952) 938-9499

Organization SubpartNo

Authorized OfficialJacquelyn K. WiersmaChief Manager · (952) 938-9499

Enumeration DateAugust 16, 2006

Last NPPES UpdateApril 5, 2017

✔ NPI 1770696726 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MN · LP1583

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

3931 AUBURN DR, Minnetonka, MN 55305

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Other Identifiers 1

Medicare PINC04437MN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacquelyn K. Wiersma, Ph. D., Lp, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Jacquelyn K. Wiersma, Ph. D., LP, PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jacquelyn Wiersma, PH. D.

Clinical Psychologist

NPI 1386757300

3931 AUBURN DR
Minnetonka, MN 55305

(952) 938-9499

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Jacquelyn K. Wiersma, Ph. D., LP, PLLC's NPI number?

The NPI number for Jacquelyn K. Wiersma, Ph. D., LP, PLLC is 1770696726. It was assigned to this organization in the NPPES registry on August 16, 2006.

Where is Jacquelyn K. Wiersma, Ph. D., LP, PLLC located?

Jacquelyn K. Wiersma, Ph. D., LP, PLLC is located at 3931 Auburn Dr, Minnetonka, MN 55305. The listed phone number is (952) 938-9499.

What is Jacquelyn K. Wiersma, Ph. D., LP, PLLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Jacquelyn K. Wiersma, Ph. D., LP, PLLC enrolled in Medicare?

Yes. Jacquelyn K. Wiersma, Ph. D., LP, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jacquelyn K. Wiersma, Ph. D., LP, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Jacquelyn K. Wiersma, Ph. D., LP, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Jacquelyn K. Wiersma, Ph. D., LP, PLLC was last updated on April 5, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years 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.