Mary Sue Zaudtke, M.A. LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3667 Issued in MN

Practice address

1250 Moore Lake Dr E Ste 220
Fridley, MN 55432-5135

Phone

(952) 388-8990

NPI assigned

Apr 11, 2006

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• A Time for Healing, LLC

  • Marriage & Family Therapist
  • Edina, MN
  • NPI 1710943089

  Psychologist

  NPD

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1669435368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 MOORE LAKE DR E STE 220",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325135",
            "telephone_number": "952-388-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 MOORE LAKE DR E STE 220",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325135",
            "telephone_number": "952-388-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAUDTKE",
        "first_name": "MARY",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "M.A. LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Filsan Ahmed Yusuf
• Maryama Osman Yusuf
• Maryan Ahmed Yusuf
• Sumaya Shamsadin Yusuf
• Brittany Rose Zales
• Kosenn Louli Zennah
• Jean Francis Zerby, LICSW
• Dawn L Ziemer, MA, LMFT
• Judith Carroll Zimmerman, MA,LMFT
• Zion Healing Center LLC

• Psychologist in Fridley, MN
• Providers in Fridley, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.