Provider Demographics
NPI:1215019252
Name:TOUSEY, CATHERINE JOYCE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JOYCE
Last Name:TOUSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13773 NE 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORESTON
Mailing Address - State:MN
Mailing Address - Zip Code:56330-9625
Mailing Address - Country:US
Mailing Address - Phone:320-968-3300
Mailing Address - Fax:
Practice Address - Street 1:13773 NE 185TH AVE
Practice Address - Street 2:
Practice Address - City:FORESTON
Practice Address - State:MN
Practice Address - Zip Code:56330-9625
Practice Address - Country:US
Practice Address - Phone:320-968-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510495Medicaid