Individual provider · Type 1 NPI

Randall R. Pottebaum

Psychologist · Burnsville, MN

NPI number 1528042223 Active

Practice location

14000 Fairview Dr, Park Nicollet Clinic Burnsville
Burnsville, MN 55337-5713

Call (952) 993-8608 Map

Mailing address

6465 Wayzata Blvd, Ste 315
St. Louis Park, MN 55426-1728

Specialties and licenses

TaxonomyCodeLicense
Psychologist Primary 103T00000X55 (MN)

Psychologist: 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 adjustmen…

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About NPI 1528042223

Randall R. Pottebaum's National Provider Identifier is 1528042223, issued on Dec 6, 2005. The primary taxonomy on file is Psychologist (103T00000X), and the practice location is in Burnsville, MN. The record was last updated on Jul 13, 2026.