Provider Demographics
NPI:1023907276
Name:KUBISTA, KATELYN SARAH (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:SARAH
Last Name:KUBISTA
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:SARAH
Other - Last Name:PADALINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:976 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6324
Mailing Address - Country:US
Mailing Address - Phone:586-707-7085
Mailing Address - Fax:
Practice Address - Street 1:10000 HWY 55 STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6433
Practice Address - Country:US
Practice Address - Phone:586-707-7085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN311401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical