Healthcare Provider Details

I. General information

NPI: 1124982525
Provider Name (Legal Business Name): KATHRYN LABORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN BRADSHAW

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MAIN ST N STE 110
STILLWATER MN
55082-5054
US

IV. Provider business mailing address

333 MAIN ST N STE 110
STILLWATER MN
55082-5054
US

V. Phone/Fax

Practice location:
  • Phone: 651-425-9297
  • Fax:
Mailing address:
  • Phone: 651-425-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP7086
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: