MEDICARE: SUSAN KRAMER LPCC

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	101YM0800X	Mental Health Counselor	CC01159	MN

General Provider Information

NPI Number	:	1770947731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KRAMER LPCC

Provider Business Mailing Address
First Line	:	4225 TECHNOLOGY DR NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5118
Country	:	US
Telephone Number	:	218-751-0282
Fax Number	:	218-751-0870

Provider Business Practice Location Address
First Line	:	4225 TECHNOLOGY DR NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5118
Country	:	US
Telephone Number	:	218-751-0282
Fax Number	:	218-751-0870

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

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	04/06/2016

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