Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | LP4051 | MN |
Y | 103TC0700X | Clinical Psychologist | LP4051 | MN |
N | 103TR0400X | Rehabilitation Psychologist | LP4051 | MN |
NPI | 1629076047 |
---|---|
Provider Name | Dr. Kathleen Jean Feil |
First Address | Marine On Saint Croix, MN 55047-8641 |
Second Address | Marine On Saint Croix, MN 55047-8641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2005 |
Last Update Date | 03/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
097L6FE | BLUE CROSS BLUE SHIELD (01) | MN |