Healthcare Provider Details

I. General information

NPI: 1649199639
Provider Name (Legal Business Name): VIENNA ADELINE ZEIDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 WAYZATA BLVD STE 100
ST LOUIS PARK MN
55426-1754
US

IV. Provider business mailing address

7035 WAYZATA BLVD STE 100
ST LOUIS PARK MN
55426-1754
US

V. Phone/Fax

Practice location:
  • Phone: 612-413-8780
  • Fax: 612-439-8903
Mailing address:
  • Phone: 612-413-8780
  • Fax: 612-439-8903

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: