Provider Demographics
NPI:1114455763
Name:FRITSCH, KATHERINE L (MA, LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:FRITSCH
Suffix:
Gender:F
Credentials:MA, LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14441 BLUEBERRY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MENAHGA
Mailing Address - State:MN
Mailing Address - Zip Code:56464-2660
Mailing Address - Country:US
Mailing Address - Phone:218-255-3279
Mailing Address - Fax:218-237-8135
Practice Address - Street 1:207 PARK AVE S # 2
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1531
Practice Address - Country:US
Practice Address - Phone:218-255-3321
Practice Address - Fax:218-237-8135
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02169101YM0800X, 101YP2500X
MN304723101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61604OtherPRIMEWEST HEALTH
MNSB720OtherBCBS
MNMNMCDOtherMEDICAID