MEDICARE: KATHERINE WIDESTROM

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	235Z00000X	Speech-Language Pathologist	7196	MN

General Provider Information

NPI Number	:	1699776252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE WIDESTROM

Provider Business Mailing Address
First Line	:	6025 109TH AVE N
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-3475
Country	:	US
Telephone Number	:	763-506-7754
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 109TH AVE N
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-3475
Country	:	US
Telephone Number	:	763-506-7754
Fax Number	:

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

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	05/07/2026

Similar Medicare Providers

1538224100 — MRS. JESSICA JEWEL HAWLEY ATC
Practice Location Address:

6025 109TH AVE N
CHAMPLIN, MN
55316-3475

Practice Phone: 952-220-1879
Practice Fax:

1619454774 — ALEC EDWARD WEIS MS, LAT, ATC, CSCS
Practice Location Address:

6025 109TH AVE N
CHAMPLIN, MN
55316-3475

Practice Phone: 763-478-1360
Practice Fax:

1396750519 — WALGREEN CO
Practice Location Address:

11401 MARKETPLACE DR N
CHAMPLIN, MN
55316-3794

Practice Phone: 763-427-6389
Practice Fax:

1194652024 — DAVID ANDREW EHLERT PHARM.D.
Practice Location Address:

11313 TRILLIUM LN N
CHAMPLIN, MN
55316-2685

Practice Phone: 763-443-7967
Practice Fax:

1235066192 — ZURICARE HOME HEALTH LLC
Practice Location Address:

10913 131ST AVE N
CHAMPLIN, MN
55316-1143

Practice Phone: 484-288-9975
Practice Fax:

1316874779 — BECOMING YOU THERAPY LLC
Practice Location Address:

11468 MARKETPLACE DR N STE 600-1024
CHAMPLIN, MN
55316-3872

Practice Phone: 507-821-3151
Practice Fax:

Directions to “ KATHERINE WIDESTROM ” 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.