Basic Information
| Provider Information | |||||||||
| NPI: | 1194232033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REANEY | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | LAGRAVE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554051430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127674858 | ||||||||
| FaxNumber: | 6128711505 | ||||||||
| Practice Location | |||||||||
| Address1: | 5050 LINCOLN DR STE 350 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127674858 | ||||||||
| FaxNumber: | 6128711505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2017 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 21316 | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 21316 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.