Provider Demographics
NPI:1093023889
Name:ANDERSON, KATHRYN J (LICENSED PSYCHOLOGIS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:15320 MINNETONKA BLVD
Mailing Address - Street 2:# 200 RELATE INC
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:952-932-7277
Mailing Address - Fax:952-932-9827
Practice Address - Street 1:15320 MINNETONKA BLVD
Practice Address - Street 2:# 200 RELATE INC
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345
Practice Address - Country:US
Practice Address - Phone:952-932-7277
Practice Address - Fax:952-932-9827
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP5250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical