Healthcare Provider Details

I. General information

NPI: 1184872897
Provider Name (Legal Business Name): CATHERINE BUTLER AVERY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 WINSLOW AVE
SAINT PAUL MN
55107-3641
US

IV. Provider business mailing address

694 WINSLOW AVE
SAINT PAUL MN
55107-3641
US

V. Phone/Fax

Practice location:
  • Phone: 612-314-6009
  • Fax:
Mailing address:
  • Phone: 612-314-6609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP5659
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: