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

Dr. Keith Wayne Fridel, PHD

Individual provider Psychologist · NPI 1215345244

Dr. Keith Wayne Fridel, PHD is a Clinical Psychologist in Shakopee, Minnesota. Qualified in 2011, 15 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Illinois.

Years since qualifying
15
Licensed in
IL
In the registry since
2014
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

1415 Saint Francis Ave
Shakopee, MN 55379-3374
Phone: (952) 993-7750
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 10640 165th St, Orland Park, IL 60467-8734 — (708) 364-0261

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X · Licence 071008852 (IL)

Record details

NPI number1215345244
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorNo
NPI enumeratedJuly 22, 2014
Last updated in NPPESMarch 17, 2018
Mailing address8170 33rd Ave S # Ms 21110q, Bloomington, MN 55425-4516

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Shakopee