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General NPI Number Information
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NPI Number | 1013989516
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Entity Type | Individual
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Provider Name | SUSAN KAY CROMWELL MSW LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 9531 W 78TH ST STE 145
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3828
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Country | US
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Telephone | 651-268-0751
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Fax | 952-943-9750
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Provider Business Mailing Address
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Address Line | 9531 W 78TH ST STE 145
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3828
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Country | US
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Telephone | 651-268-0751
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Fax | 952-943-9750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | MN
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