Healthcare Provider Details

I. General information

NPI: 1558979542
Provider Name (Legal Business Name): KATHLEEN HOVE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 WATSON AVE
SAINT PAUL MN
55116-1634
US

IV. Provider business mailing address

3395 PLYMOUTH RD
MINNETONKA MN
55305-3633
US

V. Phone/Fax

Practice location:
  • Phone: 612-405-4678
  • Fax:
Mailing address:
  • Phone: 952-548-8660
  • Fax: 952-548-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28915
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: