Provider Demographics
NPI:1831881374
Name:SCHUVER, KATIE JO (PHD,LADC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:SCHUVER
Suffix:
Gender:F
Credentials:PHD,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4434
Mailing Address - Country:US
Mailing Address - Phone:509-993-1143
Mailing Address - Fax:
Practice Address - Street 1:6936 PINE ARBOR DR S STE 200
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4672
Practice Address - Country:US
Practice Address - Phone:651-461-2903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305475101YA0400X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)