Organization
KATE KAVANAUGH, MA LP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN MARIE KAVANAUGH MA LP (PRESIDENT)
(952) 893-9791
Entity
Organization
Contact information
Practice address
9531 W. 78TH STREET, SUITE 110, EDEN PRAIRIE, MN 55344
(952) 893-9791
(952) 841-7069
Mailing address
9531 W. 78TH STREET, SUITE 110, EDEN PRAIRIE, MN 55344
(952) 893-9791
(952) 841-7069
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2468
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29G42KA
BCBS
MN
01
—
440053400
MEDICAL ASSISTANCE
MN
01
—
472664907
VALUEOPTIONS
MN
01
—
61-16357
MEDICA
MN
Enumeration date
03/14/2006
Last updated
06/03/2014
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