Healthcare Provider Details

I. General information

NPI: 1689588113
Provider Name (Legal Business Name): DESIREE KOKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15770 18TH ST NE
LITTLE FALLS MN
56345-0008
US

IV. Provider business mailing address

15770 18TH ST NE
LITTLE FALLS MN
56345-0008
US

V. Phone/Fax

Practice location:
  • Phone: 320-631-2501
  • Fax:
Mailing address:
  • Phone: 320-631-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number28237
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: