Individual
KATHLEEN MARIE KAVANAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
9531 W 78TH ST STE 110, EDEN PRAIRIE, MN 55344-8022
(952) 893-9791
(952) 841-7069
Mailing address
9531 W 78TH ST STE 110, EDEN PRAIRIE, MN 55344-8022
(952) 893-9791
(952) 841-7069
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2468
MN
Other
Enumeration date
05/23/2018
Last updated
05/23/2018
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