Provider Demographics
NPI:1760737886
Name:BEDDOW, KATHLEEN BISCHEL
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BISCHEL
Last Name:BEDDOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 6TH ST E
Mailing Address - Street 2:#3202
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1991
Mailing Address - Country:US
Mailing Address - Phone:651-238-9219
Mailing Address - Fax:
Practice Address - Street 1:168 6TH ST E
Practice Address - Street 2:#3202
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1991
Practice Address - Country:US
Practice Address - Phone:651-238-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2535106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist