Individual provider Active NPI

Judith Salsido Kumenda, MA, LPCC

  • Mental Health Counselor
  • Andover, MN
National Provider Identifier
1235685017
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
1875 Station Pkwy NW
Andover, MN 55304-3319
Phone
(763) 482-9598
NPI assigned
Aug 31, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

1875 Station Pkwy NW
Andover, MN 55304-3319

Mailing address

1875 Station Pkwy NW
Andover, MN 55304-3319
Phone (763) 482-9598

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240304001771 MN Practitioner - Mental Health Counselor 1355786088 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Rum River Counseling, Inc. CurrentSince Feb 19, 2024 Accepting new patients
Nystrom & Associates, LTD PastSince Jan 1, 2024 Accepting new patients
Family Support Services Inc. Mental Health PastSince Jan 1, 2024 Accepting new patients

Locations

1875 Station Pkwy NW
Andover, MN 55304

11870 Ulysses St NE
Ste 200
Blaine, MN 55434
Phone (651) 485-5428

11090 183rd Cir NW
Ste A
Elk River, MN 55330
Phone (763) 691-3430

18205 45th Ave N
Ste D
Plymouth, MN 55446
Phone (214) 554-4089

1619 Dayton Ave
Ste 201
Saint Paul, MN 55104
Phone (651) 645-5504

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1235685017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "763-482-9598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "763-482-9598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUMENDA",
        "first_name": "JUDITH",
        "middle_name": "SALSIDO",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MN

Sources for this page

Verify at the official NPI Registry.