Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

River Lake Clinic LLC

Organization Psychologist · NPI 1902932965

River Lake Clinic LLC is a Psychologist in Minneapolis, Minnesota. Licensed in Minnesota. Registered with an NPI since 2007.

Licensed in
MN
In the registry since
2007
Specialties on file
14
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4323 E Lake St
Minneapolis, MN 55406-2307
Phone: (612) 722-1003
Fax: (612) 721-6336
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence 1652 (MN)
Psychologist Taxonomy 103T00000X · Licence LP2754 (MN)
Adult Development & Aging Psychologist Taxonomy 103TA0700X · Licence LP2754 (MN)
Cognitive & Behavioral Psychologist Taxonomy 103TB0200X · Licence LP2754 (MN)
Counseling Psychologist Taxonomy 103TC1900X · Licence LP2754 (MN)
Family Psychologist Taxonomy 103TF0000X · Licence LP2754 (MN)
Forensic Psychologist Taxonomy 103TF0200X · Licence LP2754 (MN)
Optometrist Taxonomy 152W00000X · Licence 3331 (MN)
Corneal and Contact Management Optometrist Taxonomy 152WC0802X · Licence 3331 (MN)
Low Vision Rehabilitation Optometrist Taxonomy 152WL0500X · Licence 3331 (MN)
Pediatric Optometrist Taxonomy 152WP0200X · Licence 3331 (MN)
Sports Vision Optometrist Taxonomy 152WS0006X · Licence 3331 (MN)
Vision Therapy Optometrist Taxonomy 152WV0400X · Licence 1652 (MN)
Occupational Vision Optometrist Taxonomy 152WX0102X · Licence 1652 (MN)

Record details

NPI number1902932965
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michel Hanen-Smith — Member · (612) 722-1003
Other names River Lake Clinic
NPI enumeratedFebruary 26, 2007
Last updated in NPPESJanuary 30, 2014
Mailing address4323 E Lake St, Minneapolis, MN 55406-2307

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