Provider Demographics
NPI:1780028241
Name:MARSH, KATIE MARIE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:MARSH
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:LEWANDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:6739 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4618
Mailing Address - Country:US
Mailing Address - Phone:920-737-7961
Mailing Address - Fax:
Practice Address - Street 1:1405 LILAC DR N STE 113F
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4528
Practice Address - Country:US
Practice Address - Phone:920-737-7961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC001089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional