MEDICARE: KILLY KITZMANN LADC, LPC-IT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	307059	MN
2	101YM0800X	Mental Health Counselor	8849-226	WI

General Provider Information

NPI Number	:	1063244952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KILLY KITZMANN LADC, LPC-IT

Provider Business Mailing Address
First Line	:	800 WILSON AVE RM 330
Second Line	:
City	:	MENOMONIE
State	:	WI
Zip	:	54751-2746
Country	:	US
Telephone Number	:	715-256-7166
Fax Number	:	888-427-8048

Provider Business Practice Location Address
First Line	:	6640 SHADY OAK RD STE 401
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7834
Country	:	US
Telephone Number	:	715-256-7166
Fax Number	:	888-427-8048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	01/14/2026

Similar Medicare Providers

1518014125 — DR. CHAD MARTIN KOTERBA D.C., A.T.C.
Practice Location Address:

6640 SHADY OAK RD STE 325
EDEN PRAIRIE, MN
55344-7834

Practice Phone: 952-541-0148
Practice Fax: 952-767-2422

1023385234 — MR. RICHARD ARTHUR RITTMASTER LPCC
Practice Location Address:

6640 SHADY OAK RD STE 451
EDEN PRAIRIE, MN
55344-7834

Practice Phone: 952-746-2522
Practice Fax: 952-746-0887

1609399153 — DR. SHERYL JAYNE PLEISS PH.D., LP
Practice Location Address:

6640 SHADY OAK RD STE 375
EDEN PRAIRIE, MN
55344-7834

Practice Phone: 207-522-5497
Practice Fax:

1083220602 — GOLDFINCH NEUROBEHAVIORAL SERVICES, LLC
Practice Location Address:

6640 SHADY OAK RD STE 375
EDEN PRAIRIE, MN
55344-7834

Practice Phone: 952-236-1267
Practice Fax:

1750123014 — UNICORN THERAPY LLC
Practice Location Address:

6640 SHADY OAK RD STE 50
EDEN PRAIRIE, MN
55344-7834

Practice Phone: 612-470-2550
Practice Fax:

1124902960 — PHOENIXRISEN COUNSELING
Practice Location Address:

6640 SHADY OAK RD STE 451
EDEN PRAIRIE, MN
55344-7834

Practice Phone: 612-201-1919
Practice Fax:

Directions to “ KILLY KITZMANN LADC, LPC-IT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.