=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992669378
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAELA CHRISTINE KERNER LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1306 MARSHALL ST
-----------------------------------------------------
City | SAINT PETER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56082-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-931-8040
-----------------------------------------------------
Fax | 507-931-8060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 395
-----------------------------------------------------
City | LAKE CRYSTAL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56055-0395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 31433
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------