Provider Demographics
NPI:1881219632
Name:VALINE, KATHRYN HARTMAN (MA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HARTMAN
Last Name:VALINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 NEAL AVE N # 226
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-2177
Mailing Address - Country:US
Mailing Address - Phone:651-237-7114
Mailing Address - Fax:651-383-1867
Practice Address - Street 1:22501 JASON AVE N
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-9160
Practice Address - Country:US
Practice Address - Phone:651-237-7114
Practice Address - Fax:651-383-1867
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MNCC03834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health