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General NPI Number Information
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NPI Number | 1760695175
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Entity Type | Organization
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Legal Business Name | SUSAN K. SEARLE INC.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 09/27/2007
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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 | 952-925-8752
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Fax |
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Provider Business Mailing 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 | 952-925-8752
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUSAN KAY SEARLE
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Credential | LICSW
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Telephone | 952-925-8752
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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 | 540
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License Number State | MN
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