Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1699776252 Individual Practitioner Female Practitioner

Katherine Widestrom

Speech-Language Pathologist • Champlin, MN

Professional Overview & Biography Verified Profile Summary

Katherine Widestrom is a registered healthcare professional specializing in Speech-Language Pathologist in Champlin, MN. Practice services are available at 6025 109TH AVE N under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

6025 109th Ave N

Champlin, MN 553163475

Telephone 7635067754

Specialty Benchmarks & Practice Insights

Comparative analytics for Speech-Language Pathologist in Champlin, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 11.7 Yrs
Regional Practice Density
4 Specialists

Practicing in Champlin, MN (3097 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-05-07
Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

State License MN 7196

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
Jessica Hawley , ATC

Specialist/Technologist, Other

NPI 1538224100

Certified Athletic Trainer

Alec Weis , MS, LAT, ATC, CSCS

Specialist/Technologist - Athletic Trainer

NPI 1619454774

Master of Science, Licensed Athletic Trainer, Certified Athletic Trainer, Certified Strength and Conditioning Specialist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location May 07, 2026

Registered at 6025 109TH AVE N, CHAMPLIN, MN 553163475 (Tel: 7635067754)

📍
Updated Business Mailing Address May 07, 2026

Registered at 6025 109TH AVE N, CHAMPLIN, MN 553163475 (Tel: 7635067754)

NPI Profile Active March 18, 2010

NPI status registered as active in NPPES database

📍
Updated Practice Location March 18, 2010

Registered at 4010 W 65TH ST, SUITE 105, EDINA, MN 554351721 (Tel: 9522852840)

📍
Updated Business Mailing Address March 18, 2010

Registered at 5531 PONY AVENUE NORTH, CRYSTAL, MN 55429 (Tel: 7635359498)

👤
Provider Name / Credentials Updated March 18, 2010

Recorded as KATHERINE WIDESTROM

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 18, 2010

Speech-Language Pathologist (License #7196 in MN)

🟢
Initial NPI Registration & Enumeration August 04, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1699776252
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 04, 2005
Last Update: May 07, 2026
Sole Proprietor: No

Mailing Address

6025 109th Ave N

Champlin, MN 553163475

Phone: 7635067754

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.