Provider Demographics
NPI:1376045575
Name:STONE, KATHALEEN JO (MA)
Entity Type:Individual
Prefix:
First Name:KATHALEEN
Middle Name:JO
Last Name:STONE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATHALEEN
Other - Middle Name:
Other - Last Name:HOEMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 BOB BILLINGS PKWY APT F7
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2933
Mailing Address - Country:US
Mailing Address - Phone:763-486-0400
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-672-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6974103TC0700X
KS2829103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical