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General NPI Number Information
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NPI Number | 1972649846
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Entity Type | Individual
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Provider Name | MARY KATHERINE VERKENNES M.A. L.P.
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 25039 EAST CLARK LAKE ROAD
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City | NISSWA
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State | MN
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Zip | 56468
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Country | US
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Telephone | 218-963-2657
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Fax | 218-963-4692
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Provider Business Mailing Address
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Address Line | PO BOX 777
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City | NISSWA
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State | MN
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Zip | 56468-0777
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Country | US
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Telephone | 218-963-2657
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Fax | 218-963-4692
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP0386
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License Number State | MN
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