Katie Anne Mark, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

19335 Issued in MN

Practice address

7975 Stone Creek Dr Ste 130
Chanhassen, MN 55317-4728

Phone

(952) 544-6806

NPI assigned

Apr 15, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1306465679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16075 BOULDER CREEK DR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553456413",
            "telephone_number": "763-232-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7975 STONE CREEK DR STE 130",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553174728",
            "telephone_number": "952-544-6806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARK",
        "first_name": "KATIE",
        "middle_name": "ANNE",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-15",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luxottica of America Inc.
• Jill Renee Magnuson, MA, LP
• Carolyn C Majkrzak, PA-C
• Rebecca Angela Therese Manley, MA CCC-SLP
• Leigh Marasco, PT
• Douglas Martin
• Lindsay Jo McCain
• Ian Patrick McCann, D.C.
• McClellan Acupuncture
• Mason Ryan McClellan, LAC

• Clinical Social Worker in Chanhassen, MN
• Providers in Chanhassen, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.