Kaylene Zickmund

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

4208 Park Glen Rd
Minneapolis, MN 55416-4758

Phone

(612) 432-0735

NPI assigned

Jan 28, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• CGC LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1699239566
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1033922786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4208 PARK GLEN RD",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554164758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4208 PARK GLEN RD",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554164758",
            "telephone_number": "612-432-0735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZICKMUND",
        "first_name": "KAYLENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-28",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yan Zhou
• Kaiyuan Zhu
• Zhuanglingzi Zhuang
• Jennifer Lyn Zick, MD, PHD
• Judith Zickl
• Omar Zidan, DDS
• Yelena Ziebol, RRT
• Laura Ziegelmeyer
• Leanne Ziegeweid, COTA/L
• Richard Seth Ziegler, PHD, MD

• Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.