Provider Demographics
NPI:1720679525
Name:MACKIN, KATHERINE A (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:MACKIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S 8TH ST # S1.300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1292
Mailing Address - Country:US
Mailing Address - Phone:952-454-2294
Mailing Address - Fax:
Practice Address - Street 1:900 SOUTH 8TH STREET
Practice Address - Street 2:S1.300 COORDINATED CARE CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-873-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN266171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical