Provider Demographics
NPI:1235550575
Name:RUSSELL, CATHERINE LENORE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LENORE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1409 WILLOW ST STE 305
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3289
Mailing Address - Country:US
Mailing Address - Phone:612-325-1905
Mailing Address - Fax:888-314-7340
Practice Address - Street 1:1409 WILLOW ST
Practice Address - Street 2:STE 305
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3289
Practice Address - Country:US
Practice Address - Phone:612-325-1905
Practice Address - Fax:888-314-7340
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN204801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical