Provider Demographics
NPI:1720435175
Name:ALLEN, KATIE MARIE (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:SPITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4200 JAMES RAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-6090
Mailing Address - Country:US
Mailing Address - Phone:701-314-2300
Mailing Address - Fax:701-291-1857
Practice Address - Street 1:4200 JAMES RAY DR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6090
Practice Address - Country:US
Practice Address - Phone:701-314-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLGSW104100000X
NDLCSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1467700Medicaid