Provider Demographics
NPI:1740670645
Name:O'DONNELL BURROWS, KATHLEEN M (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:O'DONNELL BURROWS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:THE CENTER FOR VICTIMS OF TORTURE
Mailing Address - Street 2:2356 UNIVERSITY AVE W SUITE 430
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1860
Mailing Address - Country:US
Mailing Address - Phone:612-436-4873
Mailing Address - Fax:612-436-2606
Practice Address - Street 1:649 DAYTON AVE STE 430
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6631
Practice Address - Country:US
Practice Address - Phone:612-436-4873
Practice Address - Fax:612-436-2604
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN243441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical