MEDICARE: KATHERINE K THOMAS PSYD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	LP4488	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467501031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE K THOMAS PSYD.

Provider Business Mailing Address
First Line	:	980 INWOOD AVE N
Second Line	:
City	:	OAKDALE
State	:	MN
Zip	:	55128-6625
Country	:	US
Telephone Number	:	651-592-5197
Fax Number	:	651-344-0857

Provider Business Practice Location Address
First Line	:	980 INWOOD AVE N
Second Line	:
City	:	OAKDALE
State	:	MN
Zip	:	55128-6625
Country	:	US
Telephone Number	:	651-592-5197
Fax Number	:	651-344-0857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	02/13/2018

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