Healthcare Provider Details

I. General information

NPI: 1659914158
Provider Name (Legal Business Name): KATIE JANE RUBISCHKO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14665 GALAXIE AVE STE 140
APPLE VALLEY MN
55124-4509
US

IV. Provider business mailing address

7442 PINE TREE RD
LAKEVILLE MN
55044-6021
US

V. Phone/Fax

Practice location:
  • Phone: 651-456-8494
  • Fax:
Mailing address:
  • Phone: 952-210-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14120
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: