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General NPI Number Information
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NPI Number | 1720679525
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Entity Type | Individual
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Provider Name | KATHERINE A MACKIN LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 900 SOUTH 8TH STREET S1.300 COORDINATED CARE CENTER
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City | MINNEAPOLIS
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State | MN
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Zip | 55404
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Country | US
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Telephone | 612-873-6580
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Fax |
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Provider Business Mailing Address
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Address Line | 900 S 8TH ST # S1.300
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-1292
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Country | US
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Telephone | 952-454-2294
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 26617
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License Number State | MN
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