Provider Demographics
NPI:1013201847
Name:MASSMANN, KATHLEEN ROSE-PENKALA (LPCC AND M,S)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ROSE-PENKALA
Last Name:MASSMANN
Suffix:
Gender:F
Credentials:LPCC AND M,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 S CEDAR STREET
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MONTICELO
Mailing Address - State:MN
Mailing Address - Zip Code:55362
Mailing Address - Country:US
Mailing Address - Phone:651-208-9533
Mailing Address - Fax:
Practice Address - Street 1:9766 FALLON AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4589
Practice Address - Country:US
Practice Address - Phone:637-323-3517
Practice Address - Fax:763-322-5026
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health