Provider Demographics
NPI:1639188543
Name:FAVER, KATHRYN JANE (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANE
Last Name:FAVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 BELTRAMI AVE NW STE 17
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3182
Mailing Address - Country:US
Mailing Address - Phone:218-441-3632
Mailing Address - Fax:218-444-0706
Practice Address - Street 1:522 BELTRAMI AVE NW STE 17
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3182
Practice Address - Country:US
Practice Address - Phone:218-441-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN082722300Medicaid
MN11N51GAOtherBCBS OF MN
MN6271239OtherMEDICA/UBH