1740670645 NPI number — MRS. KATHLEEN M. O'DONNELL BURROWS LICSW

Table of content: MRS. KATHLEEN M. O'DONNELL BURROWS LICSW (NPI 1740670645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740670645 NPI number — MRS. KATHLEEN M. O'DONNELL BURROWS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'DONNELL BURROWS
Provider First Name:
KATHLEEN
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'DONNELL
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740670645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THE CENTER FOR VICTIMS OF TORTURE
Provider Second Line Business Mailing Address:
2356 UNIVERSITY AVE W SUITE 430
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55114-1860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-436-4873
Provider Business Mailing Address Fax Number:
612-436-2606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
649 DAYTON AVE STE 430
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104-6631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-436-4873
Provider Business Practice Location Address Fax Number:
612-436-2604
Provider Enumeration Date:
01/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  24344 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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