Provider Demographics
NPI:1295180479
Name:ONOFREYCHUK, KATIE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:ONOFREYCHUK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 EAST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2407
Mailing Address - Country:US
Mailing Address - Phone:218-728-4491
Mailing Address - Fax:218-730-2367
Practice Address - Street 1:1401 EAST 1ST STREET
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2407
Practice Address - Country:US
Practice Address - Phone:218-728-4491
Practice Address - Fax:218-730-2367
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN194241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical