Provider Demographics
NPI:1346860954
Name:BEHREND, KATIE (LBSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BEHREND
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 36TH AVE S APT 102
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8826
Mailing Address - Country:US
Mailing Address - Phone:701-639-8388
Mailing Address - Fax:
Practice Address - Street 1:3911 20TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4705
Practice Address - Country:US
Practice Address - Phone:701-271-1642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker