Provider Demographics
NPI:1841005568
Name:BRAATEN, KATY JO (LICSW)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:JO
Last Name:BRAATEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:JO
Other - Last Name:BELLEFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:WHITE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56591-0300
Mailing Address - Country:US
Mailing Address - Phone:218-368-7078
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 300
Practice Address - Street 2:
Practice Address - City:WHITE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56591-0300
Practice Address - Country:US
Practice Address - Phone:218-368-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN216101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical