Provider Demographics
NPI:1427351568
Name:FIELD-TABAKA, KATHLEEN (LICSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:FIELD-TABAKA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:FIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:17545 KODIAK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9285
Mailing Address - Country:US
Mailing Address - Phone:952-913-5698
Mailing Address - Fax:
Practice Address - Street 1:2030 RAHN WAY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2300
Practice Address - Country:US
Practice Address - Phone:651-529-1969
Practice Address - Fax:612-728-5301
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN192181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical