Healthcare Provider Details

I. General information

NPI: 1023932597
Provider Name (Legal Business Name): KOSENN LOULI ZENNAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDTRONIC PARKWAY NE
FRIDLEY MN
55432
US

IV. Provider business mailing address

5868 BAKER ROAD
MINNETONKA MN
55345
US

V. Phone/Fax

Practice location:
  • Phone: 952-767-4200
  • Fax:
Mailing address:
  • Phone: 952-767-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: