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General NPI Number Information
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NPI Number | 1528413689
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Entity Type | Individual
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Provider Name | KATIE REGER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 225 SMITH AVE N SUITE 201
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City | SAINT PAUL
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State | MN
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Zip | 55102-2533
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Country | US
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Telephone | 651-241-5119
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 FERNBROOK LN N STE 120
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City | PLYMOUTH
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State | MN
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Zip | 55447-5339
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Country | US
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Telephone |
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Fax |
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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 | LP5922
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License Number State | MN
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