Katherine Wallin, LICSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

16076 Issued in MN

Practice address

1400 12TH Ave NW
Austin, MN 55912-1912

Phone

(507) 437-9152

NPI assigned

Sep 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fernbrook Family Center, Inc

  • Social Worker
  • Owatonna, MN
  • NPI 1659483915
  Medicare reassignment NPD
• Fernbrook Family Center

  • Social Worker
  • Red Wing, MN
  • NPI 1437427911
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525046400000",
    "number": "1568561389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 FARIBAULT RD",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215780",
            "telephone_number": "507-334-1983",
            "fax_number": "507-333-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 12TH AVE NW",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559121912",
            "telephone_number": "507-437-9152"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "142 W Main St",
            "address_purpose": "LOCATION",
            "city": "Albert Lea",
            "state": "MN",
            "postal_code": "560072656",
            "country_code": "US",
            "telephone_number": "507-377-8506",
            "fax_number": "507-377-8496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLIN",
        "first_name": "KATHERINE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2018-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "16076",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "16076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "16076",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jill Marie Wagner, MS
• Bruce Kevin Waite, D.O.
• Wal-Mart Stores, Inc. (Walmart Vision CEnter 30-4257)
• Walgreen Co (Walgreens #09094)
• Walleye Dental LLC
• Walmart Inc. (Walmart Pharmacy 10-4257)
• Kim Wangen
• Wapiti Meadows Community Technologies and Services
• Wapiti Meadows Community Technologies and Services
• Rachel Lee Weatherly, RDH, BSDH, QOM

• Mental Health Counselor in Austin, MN
• Providers in Austin, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.