Healthcare Provider Details

I. General information

NPI: 1013514645
Provider Name (Legal Business Name): KATLYN MARIE ZIEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATLYN MARIE FOUKS

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WOODDALE DR STE 200
WOODBURY MN
55125-2924
US

IV. Provider business mailing address

14881 58TH ST N APT 1D
OAK PARK HEIGHTS MN
55082-4392
US

V. Phone/Fax

Practice location:
  • Phone: 612-201-2468
  • Fax:
Mailing address:
  • Phone: 715-220-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1550-140
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0032
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: