Provider Demographics
NPI:1043303647
Name:KATER, KATHY JOYCE (MSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JOYCE
Last Name:KATER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 19TH AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:NORTH ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109
Mailing Address - Country:US
Mailing Address - Phone:651-770-2693
Mailing Address - Fax:
Practice Address - Street 1:2497 7TH AVENUE EAST
Practice Address - Street 2:SUITE 109
Practice Address - City:NORTH ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109
Practice Address - Country:US
Practice Address - Phone:651-770-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN011001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical