Healthcare Provider Details

I. General information

NPI: 1093221400
Provider Name (Legal Business Name): KAYLA FERRIE MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NORTHWAY DR STE 100
SAINT CLOUD MN
56303-1258
US

IV. Provider business mailing address

1555 NORTHWAY DR
SAINT CLOUD MN
56303-4555
US

V. Phone/Fax

Practice location:
  • Phone: 651-263-7062
  • Fax:
Mailing address:
  • Phone: 320-251-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1450942
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1800901
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27584
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: