Healthcare Provider Details

I. General information

NPI: 1568323004
Provider Name (Legal Business Name): KATHRYN OCANAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19355 OXBORO AVE N
MARINE ON SAINT CROIX MN
55047-9653
US

IV. Provider business mailing address

19355 OXBORO AVE N
MARINE ON SAINT CROIX MN
55047-9653
US

V. Phone/Fax

Practice location:
  • Phone: 612-308-3242
  • Fax:
Mailing address:
  • Phone: 612-308-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number304979
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2987
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: