Healthcare Provider Details

I. General information

NPI: 1770285405
Provider Name (Legal Business Name): KATIE RSTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 BELLE AVE
MANKATO MN
56001-5250
US

IV. Provider business mailing address

1737 LA MAR DR
NORTH MANKATO MN
56003-1558
US

V. Phone/Fax

Practice location:
  • Phone: 877-877-2230
  • Fax: 507-769-0816
Mailing address:
  • Phone: 507-381-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5723
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number697541
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306930
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: