1225196512 NPI number — KATHRYN ZOFF SEIVERT PHD LP PA

Table of Contents

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)





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