Basic Information
| Provider Information | |||||||||
| NPI: | 1952586745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOGERHYDE | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | WOODS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHD, LP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WOODS | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
| OtherMiddleName: | E | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2910 CENTRE POINTE DRIVE | ||||||||
| Address2: | 35-121A | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551131182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518552327 | ||||||||
| FaxNumber: | 6518552310 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 SHERMAN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512206720 | ||||||||
| FaxNumber: | 6512206707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2007 | ||||||||
| LastUpdateDate: | 07/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | LP4891 | MN | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | LP4891 | MN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | LP4891 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TH0100X | LP4891 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Health Service |
No ID Information.