Healthcare Provider Details

I. General information

NPI: 1124368642
Provider Name (Legal Business Name): KATHERINE MACDONALD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 FLORENCE AVE
OWATONNA MN
55060-4704
US

IV. Provider business mailing address

PO BOX 4
BELLE PLAINE MN
56011-0004
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-2630
  • Fax: 507-455-8133
Mailing address:
  • Phone: 320-293-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20720
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: