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General NPI Number Information
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NPI Number | 1700094315
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Entity Type | Organization
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Legal Business Name | CENTER FOR VALIDATION & CHANGE
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 04/19/2008
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Provider Practice Location Address
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Address Line | 2024 W 3RD ST
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City | DULUTH
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State | MN
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Zip | 55806-2053
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Country | US
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Telephone | 218-722-1351
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Fax | 218-727-0875
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Provider Business Mailing Address
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Address Line | 2024 W 3RD ST
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City | DULUTH
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State | MN
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Zip | 55806-2053
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Country | US
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Telephone | 218-722-1351
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Fax | 218-727-0875
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. SUSAN ELIZABETH COOK
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Credential | LICSW
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Telephone | 218-722-1351
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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 | 12791
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License Number State | MN
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