Healthcare Provider Details

I. General information

NPI: 1780906024
Provider Name (Legal Business Name): DR. KATHLEEN ANN CHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 COUNTY ROAD D CIR E
SAINT PAUL MN
55109-6004
US

IV. Provider business mailing address

127 COUNTY ROAD C E STE 6
LITTLE CANADA MN
55117-1383
US

V. Phone/Fax

Practice location:
  • Phone: 651-335-8219
  • Fax:
Mailing address:
  • Phone: 651-335-8219
  • Fax: 651-952-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8676-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00860
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00032
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: