Healthcare Provider Details

I. General information

NPI: 1841949146
Provider Name (Legal Business Name): KAITLIN MARIE KNUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 2ND ST STE 105
EXCELSIOR MN
55331-2015
US

IV. Provider business mailing address

6745 QUEEN AVE S
RICHFIELD MN
55423-2017
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-4242
  • Fax: 952-401-4285
Mailing address:
  • Phone: 952-426-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number518136
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: