MEDICARE: SUSAN FRANCES DUNHAUPT LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	11877	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	245J5DU	OTHER	MN	BCBS OF MN
2	62-75557	OTHER	MN	UNITED BEHAVIORAL HEALTH
3	921001031398	OTHER	MN	PREFERRED ONE
4	HP21135	OTHER	MN	HEALTHPARTNERS

General Provider Information

NPI Number	:	1003943168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FRANCES DUNHAUPT LICSW

Provider Business Mailing Address
First Line	:	203 WASHINGTON ST
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-2024
Country	:	US
Telephone Number	:	612-702-0161
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 3RD AVE SE
Second Line	:	SUITE 405
City	:	ROCHESTER
State	:	MN
Zip	:	55904-4619
Country	:	US
Telephone Number	:	507-288-8544
Fax Number	:	507-288-8545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/09/2007

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