MEDICARE: KATHERINE FLUKE LIC, MFT

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
1	106H00000X	Marriage & Family Therapist	930	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1027414	OTHER	MN	PREFERRED ONE
2	47B70FL	OTHER	MN	BCBS OF MINNESOTA
3	6231631	OTHER	MN	UNITED BEHAVIORAL SYSTEMS

General Provider Information

NPI Number	:	1881807402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE FLUKE LIC, MFT

Provider Business Mailing Address
First Line	:	1404 HIGHWAY 71
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 HIGHWAY 71
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2154
Country	:	US
Telephone Number	:	218-283-3406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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