Healthcare Provider Details

I. General information

NPI: 1154555092
Provider Name (Legal Business Name): SUSAN MARIE BURNS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 LILAC DR N SUITE 151
GOLDEN VALLEY MN
55422-4535
US

IV. Provider business mailing address

6897 PAIUTE AVE STE 5
NIWOT CO
80503-7169
US

V. Phone/Fax

Practice location:
  • Phone: 763-525-9919
  • Fax: 763-525-9918
Mailing address:
  • Phone: 763-525-9919
  • Fax: 763-525-9918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13742
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: