Katie M Stadther, PSYD, LP

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

LP6595 Issued in MN

Practice address

1306 Marshall St
Saint Peter, MN 56082-4500

Phone

(507) 931-8040

NPI assigned

Oct 1, 2020

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

Other names 1

• Dr. Katie M Dietz 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

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.

• Counseling Services of Southern Minnesota, Inc

  • Clinical Social Worker
  • Saint Peter, MN
  • NPI 1962557496
  Medicare reassignment NPD

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1760089932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 MARSHALL ST",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560824500",
            "telephone_number": "507-931-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 MARSHALL ST",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560824500",
            "telephone_number": "507-931-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STADTHER",
        "first_name": "KATIE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-01",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP6595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "DIETZ",
            "middle_name": "M",
            "prefix": "DR.",
            "credential": "PSYD, LP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• St. Peter Eyecare Center
• St. Peter Public Schools
• St. Peter Regional Treatment Center
• St. Peter Regional Treatment Center
• Katie Marie Stadheim, MSW, LICSW
• Noah Stageberg
• State Operated Forensic Nursing Services
• Courtney Sticha
• Gavin Stodden
• Anthony Stordalen

• Clinical Child & Adolescent Psychologist in Saint Peter, MN
• Providers in Saint Peter, MN by specialty
• Clinical Child & Adolescent Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; 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.