Provider Demographics
NPI:1912068396
Name:CAREY, KATHLEEN T (L AC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:T
Last Name:CAREY
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1559 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2539
Mailing Address - Country:US
Mailing Address - Phone:651-698-6363
Mailing Address - Fax:651-698-2195
Practice Address - Street 1:1559 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2539
Practice Address - Country:US
Practice Address - Phone:651-698-6363
Practice Address - Fax:651-698-2195
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1327171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist