Healthcare Provider Details

I. General information

NPI: 1578685681
Provider Name (Legal Business Name): BETH ANNE SUSAG MA, MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 FREMONT AVE
SAINT PAUL MN
55106-5412
US

IV. Provider business mailing address

136 CANABURY CT
LITTLE CANADA MN
55117-1503
US

V. Phone/Fax

Practice location:
  • Phone: 612-251-8991
  • Fax:
Mailing address:
  • Phone: 612-251-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: