Wise, Kathleen Marie

Wise, Kathleen Marie is an sole proprietor health care provider with primary practice located at 7600 Bass Lake Rd Suite 106, New Hope MN 55428-3860. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Wise, Kathleen Marie can be contacted via phone (612) 865-9143.

Contact Information

Primary practice address
7600 Bass Lake Rd Suite 106 New Hope MN 55428-3860
Phone: (612) 865-9143
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X LP3227 Minnesota

Profile Details

NPI number 1871581017
LBN Legal business name Wise, Kathleen Marie
Credentials M.A., L.P.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 12th, 2005
Last updated Jul 16th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871581017 NPPES
Minnesota MEDICAID 500526400

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