Provider Demographics
NPI:1699107839
Name:KATHRYN O'CONNELL, LLC
Entity type:Organization
Organization Name:KATHRYN O'CONNELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP
Authorized Official - Phone:612-845-3554
Mailing Address - Street 1:11900 WAYZATA BLVD STE 132
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2018
Mailing Address - Country:US
Mailing Address - Phone:612-845-3554
Mailing Address - Fax:
Practice Address - Street 1:11900 WAYZATA BLVD STE 132
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2018
Practice Address - Country:US
Practice Address - Phone:612-845-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5224251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health