Healthcare Provider Details

I. General information

NPI: 1780520262
Provider Name (Legal Business Name): CLAUDETTE NDOLOKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6975 WASHINGTON AVE S
EDINA MN
55439-1511
US

IV. Provider business mailing address

6975 WASHINGTON AVE S
EDINA MN
55439-1511
US

V. Phone/Fax

Practice location:
  • Phone: 763-600-4133
  • Fax: 866-635-1990
Mailing address:
  • Phone: 763-600-4133
  • Fax: 866-635-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: