Healthcare Provider Details

I. General information

NPI: 1720901424
Provider Name (Legal Business Name): KATHERINE ANN CAROSELLA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE CAROSELLA PHD

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 WAYZATA BLVD STE 100
WAYZATA MN
55391-2064
US

IV. Provider business mailing address

17089 76TH PL N
MAPLE GROVE MN
55311-3741
US

V. Phone/Fax

Practice location:
  • Phone: 717-344-4723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP7373
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: