Healthcare Provider Details

I. General information

NPI: 1417852427
Provider Name (Legal Business Name): SUSAN C. GALLAHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 NESBITT AVE. S.
BLOOMINGTON MN
55437
US

IV. Provider business mailing address

1350 WEST 106TH STREET
BLOOMINGTON MN
55431
US

V. Phone/Fax

Practice location:
  • Phone: 952-806-7100
  • Fax:
Mailing address:
  • Phone: 952-806-7135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number101424
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: