=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467927087
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN RENEE SEMKE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2018
-----------------------------------------------------
Last Update Date | 10/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 8TH ST E
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55106-4414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-872-2017
-----------------------------------------------------
Fax | 651-229-5398
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 518 KIMBALL ST NE
-----------------------------------------------------
City | FRIDLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55432-1641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-425-0696
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CC01938
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------