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General NPI Number Information
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NPI Number | 1104898642
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Entity Type | Individual
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Provider Name | KATHLEEN M PFAFFINGER PHD LP
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Gender | Female
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 570 ASBURY ST SUITE 103
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City | SAINT PAUL
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State | MN
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Zip | 55104-1849
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Country | US
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Telephone | 651-646-1777
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Fax | 651-646-1774
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Provider Business Mailing Address
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Address Line | 528 MARSHALL AVE
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City | SAINT PAUL
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State | MN
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Zip | 55102-1721
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Country | US
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Telephone | 651-221-1963
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Fax | 651-221-9070
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3258
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License Number State | MN
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