Provider Demographics
NPI:1447704986
Name:CAVETT, KATELEEN JILL HOPE (LADC)
Entity type:Individual
Prefix:
First Name:KATELEEN
Middle Name:JILL HOPE
Last Name:CAVETT
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 YANKEE DOODLE RD APT 218
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1778
Mailing Address - Country:US
Mailing Address - Phone:651-227-5987
Mailing Address - Fax:657-925-0302
Practice Address - Street 1:1669 YANKEE DOODLE RD APT 218
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1778
Practice Address - Country:US
Practice Address - Phone:651-227-5987
Practice Address - Fax:651-925-0302
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-13
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301140101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)