Healthcare Provider Details

I. General information

NPI: 1851458582
Provider Name (Legal Business Name): KATIE LYN RICKORD MA, LP, SEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8441 WAYZATA BLVD STE 290
GOLDEN VALLEY MN
55426-1346
US

IV. Provider business mailing address

8441 WAYZATA BLVD STE 290
GOLDEN VALLEY MN
55426-1346
US

V. Phone/Fax

Practice location:
  • Phone: 612-619-0086
  • Fax: 651-344-0820
Mailing address:
  • Phone: 612-619-0086
  • Fax: 651-344-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP 5109
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: