Healthcare Provider Details

I. General information

NPI: 1790576106
Provider Name (Legal Business Name): CATHERINE MOE DALNES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 QUANTRELLE AVE NE
OTSEGO MN
55330-0168
US

IV. Provider business mailing address

17800 HALAS ST NW
RAMSEY MN
55303-3106
US

V. Phone/Fax

Practice location:
  • Phone: 763-746-9492
  • Fax:
Mailing address:
  • Phone: 952-240-4846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8393
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: