Doctor Name: | MARY KATHERINE VERKENNES |
NPI Number: | 1972649846 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. L.P. |
License Number: | LP0386 |
Business Practice Address: | 25039 East Clark Lake Road Nisswa, MN - 56468 |
Business Phone Number: | 2189632657 |
Business Fax Number: | 2189634692 |
Mailing Address: | Po Box 777, NISSWA |
State: | MN |
Postal Code: | 564680777 |
Phone Number: | 2189632657 |
Fax Number: | 2189634692 |
NPI Enumeration Date: | 01/29/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | LP0386 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |