Healthcare Provider Details

I. General information

NPI: 1912842931
Provider Name (Legal Business Name): SUSAN JANE BOBOLINK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 3RD ST E
SAINT PAUL MN
55106-5750
US

IV. Provider business mailing address

1075 3RD ST E
SAINT PAUL MN
55106-5750
US

V. Phone/Fax

Practice location:
  • Phone: 651-778-3100
  • Fax:
Mailing address:
  • Phone: 651-778-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number12808
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: