MEDICARE: SUSAN MARIE HOISINGTON PSY.D.

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	LP0881	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104974674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE HOISINGTON PSY.D.

Provider Business Mailing Address
First Line	:	1068 LAKE ST S STE 109
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2633
Country	:	US
Telephone Number	:	651-982-4792
Fax Number	:	651-982-6035

Provider Business Practice Location Address
First Line	:	1068 LAKE ST S STE 109
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2633
Country	:	US
Telephone Number	:	651-982-4792
Fax Number	:	651-982-6035

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	05/11/2026

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