Autumn Olivia Kitzmann, LP, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1477199305 Issued in MN

Practice address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789

Phone

(651) 628-9566

Fax

(651) 628-0411

NPI assigned

Nov 26, 2019

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

Other names 1

• Autumn Olivia Dow Former name

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

Specialty

Clinical Psychologist

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Nystrom & Associates, LTD

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  Medicare reassignment NPD
• Family Support Services Inc.

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD (past)
• Thrive Psychological and Consulting Services LLC

  • Professional Counselor
  • Menomonie, WI
  • NPI 1487383808
  NPD (past)

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

{
    "created_epoch": "1574726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771459200000",
    "number": "1477199305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6640 Shady Oak Rd Ste 401",
            "address_purpose": "LOCATION",
            "city": "Eden Prairie",
            "state": "MN",
            "postal_code": "553447834",
            "country_code": "US",
            "telephone_number": "715-256-7166",
            "fax_number": "888-427-8048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KITZMANN",
        "first_name": "AUTUMN",
        "middle_name": "OLIVIA",
        "credential": "LP, PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-26",
        "last_updated": "2026-02-19",
        "certification_date": "2026-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "1477199305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUTUMN",
            "last_name": "DOW",
            "middle_name": "OLIVIA",
            "credential": "LP, PSYD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kenneth Leroy King Sr.
• Kinsella Corporation
• David George Kirby, PSYD
• Jonathan Kirby, LMFT
• Vanessa Ann Kissinger, LADC
• Martha A Klug, LADC
• Kimberly Carole Knoll, LMFT
• Amber Rose Ying Knudson, MSW, LGSW
• Gillian Clare Koch, LPCC
• Elizabeth Koconsen

• Clinical Psychologist in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.