Provider Demographics
NPI:1477620425
Name:DR. KATHERINE KEGAN, LTD
Entity Type:Organization
Organization Name:DR. KATHERINE KEGAN, LTD
Other - Org Name:KATHERINE KEGAN, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-870-0980
Mailing Address - Street 1:314 CLIFTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3235
Mailing Address - Country:US
Mailing Address - Phone:612-870-0980
Mailing Address - Fax:612-872-3686
Practice Address - Street 1:314 CLIFTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3235
Practice Address - Country:US
Practice Address - Phone:612-870-0980
Practice Address - Fax:612-872-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty