Katyana Marie Wiedenman, MS

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

1119 Issued in ND

Practice address

1220 Main Ave
Suite 120
Fargo, ND 58103-8201

Phone

(701) 364-5433

Fax

(701) 364-2256

NPI assigned

Aug 31, 2010

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

• Katyana Marie Eleson Other name

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kennelly Speech-Language Pathology, LTD.Group PAC ID 8921292707, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Kennelly Speech Language Pathology LTD

  • Speech-Language Pathologist
  • Fargo, ND
  • NPI 1154370187
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413763200000",
    "number": "1770899577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 MAIN AVE",
            "address_2": "SUITE 120",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038201",
            "telephone_number": "701-364-5433",
            "fax_number": "701-364-2256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 MAIN AVE",
            "address_2": "SUITE 120",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038201",
            "telephone_number": "701-364-5433",
            "fax_number": "701-364-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDENMAN",
        "first_name": "KATYANA",
        "middle_name": "MARIE",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-31",
        "last_updated": "2014-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "1119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATYANA",
            "last_name": "ELESON",
            "middle_name": "MARIE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Adrienne Shirlene Wickenheiser, DPT
• Lindsay Wickham, MS/CCC-SLP
• Sarah Fahrenkrug Wicks, LMSW
• Megan Widmer
• Nicole Widmer
• Sara E Wiederholt, LCSW
• Jordan Ann Wiedmann, PA-C
• Lucy Wiedrich
• Shania Rose Wielenberg
• Taylor Wieler, LAPC

• Speech-Language Pathologist in Fargo, ND
• Providers in Fargo, ND by specialty
• Speech-Language Pathologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.