Healthcare Provider Details

I. General information

NPI: 1285559229
Provider Name (Legal Business Name): KATE STACKEN DAWSON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 FRANCE AVE S STE 164
EDINA MN
55435-1802
US

IV. Provider business mailing address

6600 FRANCE AVE S STE 164
EDINA MN
55435-1802
US

V. Phone/Fax

Practice location:
  • Phone: 952-600-5882
  • Fax: 844-444-0718
Mailing address:
  • Phone: 952-600-5882
  • Fax: 844-444-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLICC-1171
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: