Provider Demographics
NPI:1346085594
Name:BODE, KATRINA (LGSW)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:BODE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 WHITE OAK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2567
Mailing Address - Country:US
Mailing Address - Phone:952-443-4600
Mailing Address - Fax:952-361-5511
Practice Address - Street 1:1435 WHITE OAK DR STE 200
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2567
Practice Address - Country:US
Practice Address - Phone:952-443-4600
Practice Address - Fax:952-361-5511
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33298390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program