Provider Demographics
NPI:1508920422
Name:ZOFF-SEIVERT, KATHRYN (PHD LP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:ZOFF-SEIVERT
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OLD WEST MAIN
Mailing Address - Street 2:SUITE 329
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1993
Mailing Address - Country:US
Mailing Address - Phone:651-388-6459
Mailing Address - Fax:651-388-0778
Practice Address - Street 1:2000 OLD WEST MAIN
Practice Address - Street 2:SUITE 329
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1993
Practice Address - Country:US
Practice Address - Phone:651-388-6459
Practice Address - Fax:651-388-0778
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMNLP0699103TC0700X
MNLP0699103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
436247100OtherMHCP
1026216OtherPREF ONE
9218610226216OtherPEAK
6173554OtherMEDICA
31478ZOOtherBCBS
125189OtherU CARE
HP33728OtherHP
HP33728OtherHP