Provider Demographics
NPI:1336722701
Name:OWEN-KATONA, KRISTINE MARIE (LADC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:OWEN-KATONA
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WEST CONCORD
Mailing Address - State:MN
Mailing Address - Zip Code:55985-5004
Mailing Address - Country:US
Mailing Address - Phone:507-208-3391
Mailing Address - Fax:
Practice Address - Street 1:303 1ST AVE NE STE 365
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5297
Practice Address - Country:US
Practice Address - Phone:507-225-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302799101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)