Provider Demographics
NPI:1144600503
Name:CONERY, KATHRYN MARY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARY
Last Name:CONERY
Suffix:
Gender:F
Credentials:LICSW
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Mailing Address - Street 1:9400 ZANE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1814
Mailing Address - Country:US
Mailing Address - Phone:763-762-8800
Mailing Address - Fax:763-315-4669
Practice Address - Street 1:659 BIELENBERG DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1706
Practice Address - Country:US
Practice Address - Phone:952-903-1342
Practice Address - Fax:651-259-9770
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2020-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN212611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical