Doctor Name: | CHERYL KACK |
NPI Number: | 1184049173 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 16742 |
Business Practice Address: | 8170 Old Carriage Court North Suite 200 Shakopee, MN - 553793169 |
Business Phone Number: | 5075303852 |
Business Fax Number: | 9524653901 |
Mailing Address: | 800 E Orchard St, BELLE PLAINE |
State: | MN |
Postal Code: | 560112182 |
Phone Number: | 5075303852 |
Fax Number: | |
NPI Enumeration Date: | 02/27/2014 |
NPI Last Update Date: | 08/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 16742 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |