Provider Demographics
NPI:1265773527
Name:LANGDON, KATHRYN RYAN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:RYAN
Last Name:LANGDON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:KATE
Other - Middle Name:RYAN
Other - Last Name:LANGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:9733 KENT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:MN
Mailing Address - Zip Code:56069-4903
Mailing Address - Country:US
Mailing Address - Phone:612-227-9310
Mailing Address - Fax:
Practice Address - Street 1:9733 KENT AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:MN
Practice Address - Zip Code:56069-4903
Practice Address - Country:US
Practice Address - Phone:612-227-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical