Provider Demographics
NPI:1104597673
Name:BLOOMQUIST, KATHARINE (LMFT, CST)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:LMFT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 FORD PKWY # 8131
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1863
Mailing Address - Country:US
Mailing Address - Phone:612-568-2864
Mailing Address - Fax:
Practice Address - Street 1:2136 FORD PKWY # 8131
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1863
Practice Address - Country:US
Practice Address - Phone:612-568-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT42747106H00000X
IA100819106H00000X
MN3572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist