Healthcare Provider Details

I. General information

NPI: 1467369256
Provider Name (Legal Business Name): KATIE ANN GALL BS, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W SAINT GERMAIN ST
SAINT CLOUD MN
56301-3536
US

IV. Provider business mailing address

821 W SAINT GERMAIN ST
SAINT CLOUD MN
56301-3536
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-5381
  • Fax: 320-259-6171
Mailing address:
  • Phone: 320-259-5381
  • Fax: 320-259-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302712
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: