Provider Demographics
NPI:1679798243
Name:DONALDSON, KATE KELLEY (PHD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:KELLEY
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 EDINBOROUGH WAY
Mailing Address - Street 2:730
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5923
Mailing Address - Country:US
Mailing Address - Phone:952-896-1778
Mailing Address - Fax:952-896-1743
Practice Address - Street 1:3300 EDINBOROUGH WAY
Practice Address - Street 2:730
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5923
Practice Address - Country:US
Practice Address - Phone:952-896-1778
Practice Address - Fax:952-896-1743
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2588103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical