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General NPI Number Information
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NPI Number | 1104597673
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Entity Type | Individual
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Provider Name | KATHARINE BLOOMQUIST LMFT, CST
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Gender | Female
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Dates
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Enumeration Date | 09/24/2021
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 2136 FORD PKWY # 8131
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City | SAINT PAUL
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State | MN
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Zip | 55116-1863
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Country | US
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Telephone | 612-568-2864
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Fax |
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Provider Business Mailing Address
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Address Line | 2136 FORD PKWY # 8131
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City | SAINT PAUL
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State | MN
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Zip | 55116-1863
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Country | US
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Telephone | 612-568-2864
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 42747
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 100819
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3572
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License Number State | MN
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