Provider Demographics
NPI:1255944211
Name:MASON, KATHRYN M
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5418 WASHBURN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2435
Mailing Address - Country:US
Mailing Address - Phone:612-360-7158
Mailing Address - Fax:
Practice Address - Street 1:2639 NICOLLET AVE # 130
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1629
Practice Address - Country:US
Practice Address - Phone:612-360-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health