Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | CC01633 | MN |
NPI | 1003328816 |
---|---|
Provider Name | Kathleen Engh |
First Address | Edina, MN 55435-1810 |
Second Address | Woodbury, MN 55125-4455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2017 |
Last Update Date | 02/11/2017 |