Provider Demographics
NPI:1780906024
Name:CHARA, KATHLEEN ANN
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:CHARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 COUNTY ROAD D CIR E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-6004
Mailing Address - Country:US
Mailing Address - Phone:651-335-8219
Mailing Address - Fax:
Practice Address - Street 1:1331 COUNTY ROAD D CIR E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-6004
Practice Address - Country:US
Practice Address - Phone:651-335-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00860101YP2500X
IA00032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional