Provider Demographics
NPI:1184189540
Name:TSCHIDA, CATHLEEN ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:ANN
Last Name:TSCHIDA
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 1:5414 W OLD SHAKOPEE CIR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2766
Mailing Address - Country:US
Mailing Address - Phone:952-888-5611
Mailing Address - Fax:952-888-3741
Practice Address - Street 1:5414 W OLD SHAKOPEE CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2766
Practice Address - Country:US
Practice Address - Phone:952-888-5611
Practice Address - Fax:952-888-3741
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN184791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical