Kids Zone Development Center Inc

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

KIDS ZONE DEVELOPMENT CENTER INC

Practice address

962 University Ave W
Saint Paul, MN 55104-4703

Phone

(161) 280-6593

NPI assigned

Oct 18, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fahmo Mohamed

Title

President

Phone

(612) 280-6593

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1602979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1821697202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MARIGOLD TER NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325641",
            "telephone_number": "161-280-6593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "962 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044703",
            "telephone_number": "161-280-6593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS ZONE DEVELOPMENT CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-18",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "FAHMO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-280-6593"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Beth Kibort, PSY.D.
• Phillip M Kibort, MD
• Rodas Kidane
• Emily Jean Kidd, M.ED., LAT, ATC
• Mary Kidder
• Kathleen Ann Kiefer
• Michele Catherine Kieke, PHD, MS, LGC
• Lisa Renee Kiesel, LICSW
• Sarah J Kiesling, MD
• Marlene Kiester, CRNA

• Adolescent and Children Mental Health Clinic/Center in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Adolescent and Children Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.

Verify at the official NPI Registry.