Provider Demographics
NPI:1124368642
Name:MACDONALD, KATHERINE TERESE BOISEN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TERESE BOISEN
Last Name:MACDONALD
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 1:516 28TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2370
Mailing Address - Country:US
Mailing Address - Phone:320-293-2720
Mailing Address - Fax:
Practice Address - Street 1:1811 GREENVIEW PL SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-1002
Practice Address - Country:US
Practice Address - Phone:320-293-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical