MEDICARE: KATIE JAYNE SANDQUIST

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	101YP2500X	Professional Counselor	4769	MN
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1386279438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE JAYNE SANDQUIST

Provider Business Mailing Address
First Line	:	829 E 1ST ST APT G
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55805-3878
Country	:	US
Telephone Number	:	218-879-1227
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 W 4TH ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55806-2719
Country	:	US
Telephone Number	:	218-879-1227
Fax Number	:

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

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	11/06/2025

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Directions to “ KATIE JAYNE SANDQUIST ” Practice Location

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