Individual
MARY KATHERINE VERKENNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. L.P.
Contact information
Practice address
25039 EAST CLARK LAKE ROAD, NISSWA, MN 56468
(218) 963-2657
(218) 963-4692
Mailing address
PO BOX 777, NISSWA, MN 56468-0777
(218) 963-2657
(218) 963-4692
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP0386
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11806VE
BCBS PROVIDER ID
MN
01
—
126422
UCARE PROVIDER ID
MN
01
—
6235127
MEDICA AND BHP PROVIDER #
MN
Enumeration date
01/29/2007
Last updated
07/09/2007
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