=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770383440
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEAD THE WAY PSYCHIATRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 3RD ST SE
-----------------------------------------------------
City | KASSON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55944-2943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-910-4609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24888 710TH ST
-----------------------------------------------------
City | HAYFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55940-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-910-4609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MICHELLE KASPER
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 507-910-4609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------