Healthcare Provider Details

I. General information

NPI: 1609224104
Provider Name (Legal Business Name): CATHERINE CLONCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 WASHINGTON AVE N STE 600
MINNEAPOLIS MN
55401-1118
US

IV. Provider business mailing address

4989 N 3RD ST
LARAMIE WY
82072-9548
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax: 833-419-0181
Mailing address:
  • Phone: 307-745-8997
  • Fax: 307-742-6146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34189
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number.09930726
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127971
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12074-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: