Provider Demographics
NPI:1013137728
Name:AMUNDSON, KATHRYN A (PHD, LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67807 154TH AVE
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-7626
Mailing Address - Country:US
Mailing Address - Phone:651-565-3960
Mailing Address - Fax:
Practice Address - Street 1:3006 ALLEGRO PARK LN SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4159
Practice Address - Country:US
Practice Address - Phone:507-540-0894
Practice Address - Fax:507-281-6852
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical