Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | LP0162 | MN |
N | 103T00000X | Psychologist | LP0162 | MN |
N | 103TA0700X | Adult Development & Aging Psychologist | LP0162 | MN |
N | 103TB0200X | Cognitive & Behavioral Psychologist | LP0162 | MN |
N | 103G00000X | Clinical Psychologist | LP0162 | MN |
N | 103TC0700X | Clinical Psychologist | LP0162 | MN |
N | 103TF0000X | Family Psychologist | LP0162 | MN |
NPI | 1649328014 |
---|---|
Provider Name | Dr. Katherine Anne Kegan |
First Address | Minneapolis, MN 55403-3235 |
Second Address | Minneapolis, MN 55403-3235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |