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KILLY KITZMANN LADC, LPC-IT
NPI 1063244952
Counselor - Mental Health in Eden Prairie, MN

Active since August 19, 2024PECOS Enrolled
6640 SHADY OAK RD STE 401, EDEN PRAIRIE, MN 55344(715) 256-7166(888) 427-8048 Get Directions Write a Review

NPPES record last updated: January 14, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 14, 2026, Sep 11, 2024, Aug 19, 2024 (3 updates tracked since 2024).

About Killy Kitzmann Ladc, Lpc-it NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KILLY KITZMANN LADC, LPC-IT (NPI 1063244952) is an individual mental health provider in Eden Prairie, Minnesota, licensed in Wisconsin (8849-226) and active in the NPI registry since August 2024. He is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1063244952
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameKILLY KITZMANNCredential: LADC, LPC-IT
Location Address6640 SHADY OAK RD STE 401Eden Prairie, MN 55344-7834
Mailing Address800 Wilson Ave Rm 330Menomonie, WI 54751-2746 · (715) 256-7166 · Fax (888) 427-8048
Phone(715) 256-7166
Fax(888) 427-8048
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateAugust 19, 2024
Last NPPES UpdateJanuary 14, 20263 updates tracked since enumeration
NPPES CertifiedJanuary 14, 2026
✔ NPI 1063244952 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in WI · 8849-226
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 307059 (MN)
6640 SHADY OAK RD STE 401, Eden Prairie, MN 55344
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Killy Kitzmann Ladc, Lpc-it is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4880178052
PECOS Enrollment IDI20260325002940
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ABBIE LUPELOW
Counselor (Professional)
6640 SHADY OAK RD STE 401
EDEN PRAIRIE, MN 55344
Hennepin County (715) 256-7166

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Killy Kitzmann's NPI number?

The NPI number for Killy Kitzmann is 1063244952. It was assigned to this individual provider in the NPPES registry on August 19, 2024.

Where is Killy Kitzmann located?

Killy Kitzmann practices at 6640 Shady Oak Rd Ste 401, Eden Prairie, MN 55344. The listed phone number is (715) 256-7166.

What is Killy Kitzmann's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Killy Kitzmann enrolled in Medicare?

Yes. Killy Kitzmann is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Killy Kitzmann was last updated on January 14, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.