1225196512 NPI number — KATHRYN ZOFF SEIVERT PHD LP PA

Table of content: (NPI 1225196512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225196512 NPI number — KATHRYN ZOFF SEIVERT PHD LP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHRYN ZOFF SEIVERT PHD LP PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225196512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
854 SO. ROBERT ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55107-3258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-388-6459
Provider Business Mailing Address Fax Number:
952-241-9225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 OLD WEST MAIN
Provider Second Line Business Practice Location Address:
SUITE 329
Provider Business Practice Location Address City Name:
RED WING
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55066-1993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-388-6459
Provider Business Practice Location Address Fax Number:
952-241-9225
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZOFF-SEIVERT
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
Authorized Official Title or Position:
LIC PSYCHOLOGIST
Authorized Official Telephone Number:
651-388-6459

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  MNLP0699 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com