Provider Demographics
NPI:1104898642
Name:PFAFFINGER, KATHLEEN M (PHD LP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:PFAFFINGER
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:528 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1721
Mailing Address - Country:US
Mailing Address - Phone:651-221-1963
Mailing Address - Fax:651-221-9070
Practice Address - Street 1:570 ASBURY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1849
Practice Address - Country:US
Practice Address - Phone:651-646-1777
Practice Address - Fax:651-646-1774
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3258103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical