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NPI Code Detail

MEDICARE: KATE R. MAKINEN MSW, LGSW, LADC

MEDICARE: KATE R. MAKINEN MSW, LGSW, LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker26388MN
2101YA0400XAddiction (Substance Use Disorder) Counselor303991MN

General Provider Information

NPI Number : 1124549571
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATE R. MAKINEN MSW, LGSW, LADC
Provider Business Mailing Address
First Line : 2086 RIDGEWAY DR
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-4421
Country : US
Telephone Number : 218-327-9944
Fax Number : 218-327-9375
Provider Business Practice Location Address
First Line : 2086 RIDGEWAY DR
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-4421
Country : US
Telephone Number : 218-327-9944
Fax Number : 218-327-9375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2017
Last Update Date : 07/21/2022

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