Katherine Proveaux, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

23661 Issued in MN

Practice address

324 W Superior St Ste 620
Duluth, MN 55802-1723

Phone

(218) 606-1797

NPI assigned

Mar 13, 2024

Last updated

Mar 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Opted out of Medicare

Yes, effective Jul 9, 2024 through Jul 9, 2028

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amp Group, LLC

  • Professional Counselor
  • Duluth, MN
  • NPI 1134664311
  NPD

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

{
    "created_epoch": "1710288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1609634617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 W SUPERIOR ST STE 620",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021723",
            "telephone_number": "218-606-1797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 W SUPERIOR ST STE 620",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021723",
            "telephone_number": "218-606-1797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVEAUX",
        "first_name": "KATHERINE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-13",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "23661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanner Prochaska
• Jennifer A Prom, PAC
• Kiley Rae Pronschinske, MSW, LICSW
• Michelle A Proska, APRN, CNP
• Laura Prouty
• Providacare Medical Supply LTD
• Anna Marie Prusak
• Lisa Sitzmann Prusak
• Mara Patricia Prusak, RN, CRNA
• Rachel Przybilla

• Clinical Social Worker in Duluth, MN
• Providers in Duluth, 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 Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.