Provider Demographics
NPI:1093870735
Name:FEDER, KATHARINE SUSAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:SUSAN
Last Name:FEDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 S GRAND BLVD
Mailing Address - Street 2:400 A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1034
Mailing Address - Country:US
Mailing Address - Phone:314-956-4014
Mailing Address - Fax:
Practice Address - Street 1:3115 S GRAND BLVD
Practice Address - Street 2:400 A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1034
Practice Address - Country:US
Practice Address - Phone:314-956-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011007405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical