Provider Demographics
NPI:1225522584
Name:ANGELL, KATIE J (MSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:ANGELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 COUNTY ROAD 101 SUITE 300
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:952-932-7277
Mailing Address - Fax:952-932-9827
Practice Address - Street 1:5125 COUNTY ROAD 101 SUITE 300
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345
Practice Address - Country:US
Practice Address - Phone:952-932-7277
Practice Address - Fax:952-932-9827
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist