Provider Demographics
NPI:1841803004
Name:ROUSE, KALI KATHERINE (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:KALI
Middle Name:KATHERINE
Last Name:ROUSE
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 1:6734 BERKSHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3531
Mailing Address - Country:US
Mailing Address - Phone:920-328-3551
Mailing Address - Fax:
Practice Address - Street 1:11800 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2010
Practice Address - Country:US
Practice Address - Phone:612-271-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN265401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical