Provider Demographics
NPI:1477699577
Name:MARSH, M. KATHARINE (MA LADC)
Entity Type:Individual
Prefix:MS
First Name:M.
Middle Name:KATHARINE
Last Name:MARSH
Suffix:
Gender:F
Credentials:MA LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15624 WING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5649
Mailing Address - Country:US
Mailing Address - Phone:952-928-4866
Mailing Address - Fax:
Practice Address - Street 1:4601 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 507A
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4960
Practice Address - Country:US
Practice Address - Phone:952-220-9712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302037101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)