Provider Demographics
NPI:1164650560
Name:MAHAFFEY, KATHERINE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:J
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-2043
Mailing Address - Country:US
Mailing Address - Phone:507-931-8040
Mailing Address - Fax:507-931-8060
Practice Address - Street 1:116 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2043
Practice Address - Country:US
Practice Address - Phone:507-931-8040
Practice Address - Fax:507-931-8060
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4959103TC0700X, 103TF0200X
WY418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic