Healthcare Provider Details

I. General information

NPI: 1912490376
Provider Name (Legal Business Name): KIMBERLY LITKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10417 EXCELSIOR BLVD STE 2
HOPKINS MN
55343-3440
US

IV. Provider business mailing address

600 25TH AVE S STE 106
SAINT CLOUD MN
56301-4820
US

V. Phone/Fax

Practice location:
  • Phone: 952-395-3018
  • Fax:
Mailing address:
  • Phone: 320-257-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2834
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: