MEDICARE: DR. KATHERINE ANNE KEGAN PHD

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	103T00000X	Psychologist	LP0162	MN
2	103TA0700X	Adult Development & Aging Psychologist	LP0162	MN
3	103TB0200X	Cognitive & Behavioral Psychologist	LP0162	MN
4	103TC0700X	Clinical Psychologist	LP0162	MN
5	103TF0000X	Family Psychologist	LP0162	MN

General Provider Information

NPI Number	:	1649328014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE ANNE KEGAN PHD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	12/02/2025

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