Provider Demographics
NPI:1548444292
Name:SCHUPP, ANNA JELBERT BOGESTAD (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:JELBERT BOGESTAD
Last Name:SCHUPP
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Gender:F
Credentials:PSYD, LP
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Mailing Address - Street 1:12301 WHITEWATER DR
Mailing Address - Street 2:STE 101
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9447
Mailing Address - Country:US
Mailing Address - Phone:952-999-6097
Mailing Address - Fax:952-426-0508
Practice Address - Street 1:12301 WHITEWATER DR
Practice Address - Street 2:STE 101
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9447
Practice Address - Country:US
Practice Address - Phone:952-999-6097
Practice Address - Fax:952-426-0508
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2016-12-23
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Provider Licenses
StateLicense IDTaxonomies
MNLP5293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1548444292Medicaid
MN1548444292Medicaid
MN080405400Medicaid