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General NPI Number Information
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NPI Number | 1063065019
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Entity Type | Individual
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Provider Name | SUSAN M DOLPH LICSW
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Gender | Female
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 5723 GRAND AVE STE 2
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City | DULUTH
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State | MN
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Zip | 55807-2567
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Country | US
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Telephone | 218-461-6468
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Fax | 218-212-9933
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Provider Business Mailing Address
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Address Line | 5723 GRAND AVE STE 2
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City | DULUTH
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State | MN
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Zip | 55807-2567
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Country | US
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Telephone | 218-461-6468
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Fax | 218-212-9933
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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 | 9614-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 13359
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13359
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License Number State | MN
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