Active NPI
Kaylee Nadine Frederickson, SLP
- Speech-Language Pathologist
- Burnsville, MN
National Provider Identifier
1639717986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 10310
- Practice address
- 14451 Grand Ave S
Burnsville, MN 55306 - Phone
- (952) 993-5900
- NPI assigned
- Dec 17, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 10310 | MN | Primary |
Addresses
Primary practice location
14451 Grand Ave S
Burnsville, MN 55306
Mailing address
3440 Dupont Ave S Apt 204
Minneapolis, MN 55408-4069
Phone (920) 257-9647
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10310 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Clinic | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinic/Center
- St Louis Park, MN
- NPI 1275232423
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578268800000",
"number": "1639717986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3440 DUPONT AVE S APT 204",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554084069",
"telephone_number": "920-257-9647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14451 GRAND AVE S",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "55306",
"telephone_number": "952-993-5900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICKSON",
"first_name": "KAYLEE",
"middle_name": "NADINE",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-17",
"last_updated": "2020-01-06",
"certification_date": "2020-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "10310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.