Healthcare Provider Details

I. General information

NPI: 1508787235
Provider Name (Legal Business Name): SUSAN NELSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 GREENHAVEN RD STE 204
ANOKA MN
55303-1675
US

IV. Provider business mailing address

540 GREENHAVEN RD STE 204
ANOKA MN
55303-1675
US

V. Phone/Fax

Practice location:
  • Phone: 763-203-3164
  • Fax: 651-925-0524
Mailing address:
  • Phone: 763-203-3164
  • Fax: 651-925-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17752
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: