Healthcare Provider Details

I. General information

NPI: 1104974674
Provider Name (Legal Business Name): SUSAN MARIE HOISINGTON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 LAKE ST S STE 109
FOREST LAKE MN
55025-2633
US

IV. Provider business mailing address

1068 LAKE ST S STE 109
FOREST LAKE MN
55025-2633
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-4792
  • Fax: 651-982-6035
Mailing address:
  • Phone: 651-982-4792
  • Fax: 651-982-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberLP0881
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: