MEDICARE: KATHEREINE MARIE VANDERWEYST OWNER

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	253J00000X	Foster Care Agency	1087053-1-HCBS	MN
2	237700000X	Hearing Instrument Specialist	2835	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982133880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHEREINE MARIE VANDERWEYST OWNER

Provider Business Mailing Address
First Line	:	324 BROADWAY ST STE 210
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-2688
Country	:	US
Telephone Number	:	320-815-9065
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 BROADWAY ST STE 210
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-2688
Country	:	US
Telephone Number	:	320-815-9065
Fax Number	:

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	04/24/2026

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