Provider Demographics
NPI:1578655478
Name:SANDERS, KATHRYNE ELIZABETH (MEQ, LP)
Entity Type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:ELIZABETH
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MEQ, LP
Other - Prefix:
Other - First Name:KATHRYNE
Other - Middle Name:ELIZABETH
Other - Last Name:LOUCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEQ
Mailing Address - Street 1:585 HEINEL DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2108
Mailing Address - Country:US
Mailing Address - Phone:651-490-1126
Mailing Address - Fax:
Practice Address - Street 1:585 HEINEL DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2108
Practice Address - Country:US
Practice Address - Phone:651-490-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1847103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist