MEDICARE: DR. KATHLEEN JEAN FEIL PHD, LP

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	103TR0400X	Rehabilitation Psychologist	LP4051	MN
2	103TC0700X	Clinical Psychologist	LP4051	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	097L6FE	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1629076047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN JEAN FEIL PHD, LP

Provider Business Mailing Address
First Line	:	189 EGRET LN
Second Line	:
City	:	MARINE ON SAINT CROIX
State	:	MN
Zip	:	55047-8641
Country	:	US
Telephone Number	:	651-308-5581
Fax Number	:

Provider Business Practice Location Address
First Line	:	189 EGRET LN
Second Line	:
City	:	MARINE ON SAINT CROIX
State	:	MN
Zip	:	55047-8641
Country	:	US
Telephone Number	:	651-308-5581
Fax Number	:

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	09/03/2019

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