Provider Demographics
NPI:1730365800
Name:GIESELMAN, KATHY ANNE (MA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANNE
Last Name:GIESELMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATHIE
Other - Middle Name:
Other - Last Name:GIESELMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, LPCC
Mailing Address - Street 1:5861 CEDAR LAKE RD S
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1653
Mailing Address - Country:US
Mailing Address - Phone:122-028-7036
Mailing Address - Fax:612-241-1943
Practice Address - Street 1:5861 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1653
Practice Address - Country:US
Practice Address - Phone:952-202-8703
Practice Address - Fax:612-241-1943
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55690106H00000X
MN1900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27382Medicaid