Provider Demographics
NPI:1295988343
Name:BERSCHEID, KATHRYN (LADC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BERSCHEID
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10724 FANNON AVE SE
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8340
Mailing Address - Country:US
Mailing Address - Phone:612-978-5494
Mailing Address - Fax:763-972-2879
Practice Address - Street 1:10724 FANNON AVE SE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8340
Practice Address - Country:US
Practice Address - Phone:612-978-5494
Practice Address - Fax:763-972-2879
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302284101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)