Provider Demographics
NPI:1417008095
Name:VREEMAN, KATHERINE GRACE (MSSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:GRACE
Last Name:VREEMAN
Suffix:
Gender:F
Credentials:MSSW, LICSW
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:HARRIES
Other - Last Name:MUELLNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSSW, LICSW
Mailing Address - Street 1:6005 SALEM RD SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-8825
Mailing Address - Country:US
Mailing Address - Phone:507-281-3033
Mailing Address - Fax:
Practice Address - Street 1:6005 SALEM RD SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-8825
Practice Address - Country:US
Practice Address - Phone:507-281-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5211185OtherMN TAX ID
68B56MUOtherBHSI INDIVIDUAL PROVIDER
136561OtherU-CARE PRACTICE PROVIDER
MN68B54MUOtherBCBS CONTRACTING PROVIDER
MN68B56MUOtherBCBS INDIVIDUAL PROVIDER
120874OtherMMSI PROVIDER #
68B54MUOtherBHSI AGENCY PROVIDER
150611OtherU-CARE INDIVIDUAL PROVIDE