Provider Demographics
NPI:1790097327
Name:INNER OUTFITTERS, INC
Entity Type:Organization
Organization Name:INNER OUTFITTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:KACHER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:612-874-8608
Mailing Address - Street 1:1409 WILLOW ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2269
Mailing Address - Country:US
Mailing Address - Phone:612-874-8608
Mailing Address - Fax:612-874-8612
Practice Address - Street 1:1409 WILLOW ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2269
Practice Address - Country:US
Practice Address - Phone:612-874-8608
Practice Address - Fax:612-874-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN019761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1609932540OtherNPI INDIVIDUAL NUMBER
MN800001233Medicare PIN