Premier Sport Psychology, PLLC

Psychologist in Edina, MN. Organization (NPI-2).

NPI number1104779586

StatusActive

Last updated in NPPESFeb 17, 2026

Details

NPI: 1104779586
Entity type: Organization (NPI-2)
Legal business name: Premier Sport Psychology, PLLC
Organization subpart: No
Enumeration date: Feb 17, 2026
Certification date: Feb 17, 2026
Last updated: Feb 17, 2026

Medicare and OIG

Medicare enrolled (PECOS): Not in the Medicare enrollment file
Can order and refer: Not on the CMS order and referring list
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
103T00000X	Psychologist	–	–	Yes

Practice location

7401 Metro Blvd Ste 510
Edina, MN 55439-3033

Phone 952-835-8513

Mailing address

7401 Metro Blvd Ste 510
Edina, MN 55439-3033

Phone 952-835-8513

Authorized official

Chadric Rasmussen
Director Of Finance & Operations
9524562910

Is something wrong?

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Other Psychologist providers in Edina, MN

All 81 Psychologist providers in Edina · All 4,659 providers in Edina

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