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NPI Code Detail

MEDICARE: KATYA MICKELSON MA

MEDICARE: KATYA MICKELSON MA
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
1103T00000XPsychologistND1019ND

General Provider Information

NPI Number : 1750061842
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATYA MICKELSON MA
Provider Business Mailing Address
First Line : 3535 S 31ST ST STE 201
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-3593
Country : US
Telephone Number : 701-780-6821
Fax Number : 701-780-1973
Provider Business Practice Location Address
First Line : 3535 S 31ST ST STE 201
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-3593
Country : US
Telephone Number : 701-780-6821
Fax Number : 701-780-1973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2023
Last Update Date : 02/16/2026

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Directions to “ KATYA MICKELSON MA” Practice Location

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