Healthcare Provider Details

I. General information

NPI: 1659775104
Provider Name (Legal Business Name): KATHERINE ROSE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. KATHERINE ROSE LICHTBLAU

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

985450 NEBRASKA MEDICAL CTR
OMAHA NE
68198-5450
US

V. Phone/Fax

Practice location:
  • Phone: 763-525-1746
  • Fax:
Mailing address:
  • Phone: 402-559-8863
  • Fax: 402-559-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10907
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11569185-2506
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4966
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: