Organization
KATE KAVANAUGH, MA LP, PA
Active
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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