Basic Information
Provider Information | |||||||||
NPI: | 1639149750 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | O'NEILL | ||||||||
FirstName: | H. KATHERINE | ||||||||
MiddleName: | KIT | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1401 13TH AVE E | ||||||||
Address2: |   | ||||||||
City: | WEST FARGO | ||||||||
State: | ND | ||||||||
PostalCode: | 580783468 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7013640060 | ||||||||
FaxNumber: | 7013640065 | ||||||||
Practice Location | |||||||||
Address1: | 1401 13TH AVE E | ||||||||
Address2: |   | ||||||||
City: | WEST FARGO | ||||||||
State: | ND | ||||||||
PostalCode: | 580783468 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7013640060 | ||||||||
FaxNumber: | 7013640065 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/23/2006 | ||||||||
LastUpdateDate: | 01/29/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 223 | ND | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
ID | Type | State | Issuer | Description | 475441011696 | 01 |   | PREFERRED ONE | OTHER | 61-27796 | 01 |   | MEDICA (UBH) | OTHER | 354S4ON | 01 | MN | BLUECROSS/SHIELD MINNESOT | OTHER | 18838 | 05 | ND |   | MEDICAID | 21949 | 01 | ND | BLUECROSS/SHIELD NODAK | OTHER | HP20185 | 01 |   | HEALTHPARTNERS | OTHER |