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General NPI Number Information
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NPI Number | 1265180970
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Entity Type | Individual
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Provider Name | SUSAN MARIE SHOULTZ LCMT
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Gender | Female
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 5315 LYNDALE AVE S STE A
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-1285
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Country | US
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Telephone | 612-223-8064
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Fax |
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Provider Business Mailing Address
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Address Line | 14440 28TH PL N STE 200
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City | PLYMOUTH
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State | MN
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Zip | 55447-4854
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Country | US
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Telephone | 321-772-8226
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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 | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227-016917
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License Number State | IL
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