Provider Demographics
NPI:1659914158
Name:RUBISCHKO, KATIE JANE (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JANE
Last Name:RUBISCHKO
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7442 PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6021
Mailing Address - Country:US
Mailing Address - Phone:952-210-4936
Mailing Address - Fax:
Practice Address - Street 1:101 W BURNSVILLE PKWY
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2571
Practice Address - Country:US
Practice Address - Phone:612-548-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN141201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical