Provider Demographics
NPI:1073602306
Name:TJEPKEMA, KATHRYN ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:TJEPKEMA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1246
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-1246
Mailing Address - Country:US
Mailing Address - Phone:507-377-5453
Mailing Address - Fax:507-377-5505
Practice Address - Street 1:203 W CLARK ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2549
Practice Address - Country:US
Practice Address - Phone:507-377-5453
Practice Address - Fax:507-377-5505
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN053231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical