Healthcare Provider Details

I. General information

NPI: 1346265279
Provider Name (Legal Business Name): KATHLEEN J. FEIL, PHD, LP, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 EGRET LN
MARINE ON SAINT CROIX MN
55047-8641
US

IV. Provider business mailing address

PO BOX 163
MARINE ON SAINT CROIX MN
55047-0163
US

V. Phone/Fax

Practice location:
  • Phone: 651-308-5581
  • Fax:
Mailing address:
  • Phone: 651-308-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4051
License Number StateMN

VIII. Authorized Official

Name: DR. KATHLEEN JEAN FEIL
Title or Position: OWNER
Credential: PHD
Phone: 651-308-5581