Healthcare Provider Details

I. General information

NPI: 1891186847
Provider Name (Legal Business Name): KATRINA RUDE MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 GRAND AVE
SAINT PAUL MN
55105-3401
US

IV. Provider business mailing address

4219 MINNEHAHA AVE
MINNEAPOLIS MN
55406-3303
US

V. Phone/Fax

Practice location:
  • Phone: 651-212-4920
  • Fax:
Mailing address:
  • Phone: 612-219-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC01588
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: