Provider Demographics
NPI:1558413393
Name:CRANBROOK, KATHERYN ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHERYN
Middle Name:ANN
Last Name:CRANBROOK
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 1:2354 PARKWOODS RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1973
Mailing Address - Country:US
Mailing Address - Phone:952-919-9182
Mailing Address - Fax:952-936-7096
Practice Address - Street 1:3100 W LAKE ST
Practice Address - Street 2:#410
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4527
Practice Address - Country:US
Practice Address - Phone:952-933-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3531103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist