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General NPI Number Information
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NPI Number | 1770285405
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Entity Type | Individual
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Provider Name | KATIE RSTOM
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 304 BELLE AVE
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City | MANKATO
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State | MN
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Zip | 56001-5250
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Country | US
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Telephone | 877-877-2230
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Fax | 507-769-0816
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Provider Business Mailing Address
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Address Line | 1737 LA MAR DR
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City | NORTH MANKATO
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State | MN
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Zip | 56003-1558
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Country | US
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Telephone | 507-381-0698
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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Taxonomy #3
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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