| Doctor Name: | MS. KATELYN MARIAH |
| NPI Number: | 1063579936 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A, LICSW |
| License Number: | 07301 |
| Business Practice Address: | 7600 Boone Ave N Brooklyn Park, MN - 554284563 |
| Business Phone Number: | 7635152452 |
| Business Fax Number: | 7635152442 |
| Mailing Address: | 1641 Hague Ave, SAINT PAUL |
| State: | MN |
| Postal Code: | 551046236 |
| Phone Number: | 6516468306 |
| Fax Number: | 7635152442 |
| NPI Enumeration Date: | 01/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 07301 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |