Provider Demographics
NPI:1942805247
Name:EDER, KATHERINE J
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:EDER
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 1:1300 GRAND ST NE APT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1049
Mailing Address - Country:US
Mailing Address - Phone:651-413-0327
Mailing Address - Fax:
Practice Address - Street 1:822 S 3RD ST STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1200
Practice Address - Country:US
Practice Address - Phone:612-568-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health