Provider Demographics
NPI:1033940101
Name:BLESENER, KATHERINE ANNE (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANNE
Last Name:BLESENER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:DOOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4660 SLATER RD STE 145
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4047
Mailing Address - Country:US
Mailing Address - Phone:651-440-9159
Mailing Address - Fax:651-371-3139
Practice Address - Street 1:4660 SLATER RD STE 145
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4047
Practice Address - Country:US
Practice Address - Phone:651-440-9159
Practice Address - Fax:651-371-3139
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC040507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health