MEDICARE: DR. KATHERINE KEGAN, LTD

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	LP0162	MN

General Provider Information

NPI Number	:	1477620425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. KATHERINE KEGAN, LTD

Provider Business Mailing Address
First Line	:	314 CLIFTON AVE
Second Line	:	SUITE 103
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3235
Country	:	US
Telephone Number	:	612-870-0980
Fax Number	:	612-872-3686

Provider Business Practice Location Address
First Line	:	314 CLIFTON AVE
Second Line	:	SUITE 103
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3235
Country	:	US
Telephone Number	:	612-870-0980
Fax Number	:	612-872-3686

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. KATHERINE ANNE KEGAN
Credential	:	PHD
Telephone Number	:	612-870-0980

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/22/2020

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