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General NPI Number Information
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NPI Number | 1184775538
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Entity Type | Individual
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Provider Name | SUSAN K SEARLE LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/14/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 5009 EXCELSIOR BLVD SUITE 112
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-3041
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Country | US
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Telephone | 952-926-8752
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Fax |
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Provider Business Mailing Address
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Address Line | 4912 CLINTON AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-5661
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Country | US
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Telephone | 612-825-0786
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 540
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 540
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License Number State | MN
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