| Kate Kavanaugh, Ma Lp, Pa | |
|
9531 W. 78th Street Suite 110 Eden Prairie MN 55344 | |
| (952) 893-9791 | |
| (952) 841-7069 |
| Full Name | Kate Kavanaugh, Ma Lp, Pa |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 9531 W. 78th Street, Eden Prairie, Minnesota |
| Authorized Official Name and Position | Kathleen Marie Kavanaugh (PRESIDENT) |
| Authorized Official Contact | 9528939791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kate Kavanaugh, Ma Lp, Pa 9531 W. 78th Street Suite 110 Eden Prairie MN 55344 Ph: (952) 893-9791 | Kate Kavanaugh, Ma Lp, Pa 9531 W. 78th Street Suite 110 Eden Prairie MN 55344 Ph: (952) 893-9791 |
| NPI Number | 1396714234 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 06/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396714234 | NPI | - | NPPES |
| 440053400 | Other | MN | MEDICAL ASSISTANCE |
| 61-16357 | Other | MN | MEDICA |
| 472664907 | Other | MN | VALUEOPTIONS |
| 29G42KA | Other | MN | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP2468 (Minnesota) | Primary |
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