Provider Demographics
NPI:1629076047
Name:FEIL, KATHLEEN JEAN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JEAN
Last Name:FEIL
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:JEAN
Other - Last Name:FEIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:189 EGRET LN
Mailing Address - Street 2:
Mailing Address - City:MARINE ON SAINT CROIX
Mailing Address - State:MN
Mailing Address - Zip Code:55047-8641
Mailing Address - Country:US
Mailing Address - Phone:651-308-5581
Mailing Address - Fax:
Practice Address - Street 1:189 EGRET LN
Practice Address - Street 2:
Practice Address - City:MARINE ON SAINT CROIX
Practice Address - State:MN
Practice Address - Zip Code:55047-8641
Practice Address - Country:US
Practice Address - Phone:651-308-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4051103TR0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN097L6FEOtherBLUE CROSS BLUE SHIELD