Provider Demographics
NPI:1497015424
Name:KERKHOFF, KATIA ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATIA
Middle Name:ANN
Last Name:KERKHOFF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATIA
Other - Middle Name:ANN
Other - Last Name:GRENELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5255 MEMBERS PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8381
Mailing Address - Country:US
Mailing Address - Phone:507-218-3701
Mailing Address - Fax:
Practice Address - Street 1:5255 MEMBERS PKWY NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901
Practice Address - Country:US
Practice Address - Phone:507-218-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN186781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800002978Medicare PIN