Provider Demographics
NPI:1760089932
Name:STADTHER, KATIE M (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:M
Last Name:STADTHER
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:1306 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-4500
Mailing Address - Country:US
Mailing Address - Phone:507-931-8040
Mailing Address - Fax:
Practice Address - Street 1:1306 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-4500
Practice Address - Country:US
Practice Address - Phone:507-931-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6595103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent