Healthcare Provider Details

I. General information

NPI: 1073997128
Provider Name (Legal Business Name): KATE JODELL BEAMAN FRIESNER MA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 FIRST STREET NORTH
HACKENSACK MN
56452
US

IV. Provider business mailing address

PO BOX 471
HACKENSACK MN
56452-0471
US

V. Phone/Fax

Practice location:
  • Phone: 218-675-5101
  • Fax:
Mailing address:
  • Phone: 218-675-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: