Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | LP4556 | MN |
N | 103G00000X | Clinical Psychologist | LP4556 | MN |
N | 103TC0700X | Clinical Psychologist | LP4556 | MN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LP4556 | MN |
N | 103TH0100X | Health Service | LP4556 | MN |
NPI | 1144316449 |
---|---|
Provider Name | Dr. Gretchen Lea Kafer |
First Address | Lindstrom, MN 55045-7336 |
Second Address | Coon Rapids, MN 55433-5861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |