SUSAN GUSTAFSON (NPI# 1073686655) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073686655 |
| Entity Type | Individual |
| Full Name | SUSAN GUSTAFSON |
| Credential | LP |
| Practice Address |
219 Se Main St Ste 400 Minneapolis MN 55414-2151 |
| Practice Telephone | 6128862524 |
| Practice Fax Number | 6128862538 |
| Mailing Telephone | 6128862524 |
| Mailing Fax Number | 6128862538 |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2017-08-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
LP3594 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MEDICA CHOICE | 6153482 | 01 |
| MN | HEALTHPARTNERS | HP49453 | 01 |
| MN | BCBS | 54P16GU | 01 |
| FM | 025523800 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205214350 | Susan Stephanie Gustafson | Licensed Practical Nurse | 7951 250th St, Forest Lake, MN 55025-8370 | 2015-05-09 |
| 1760616759 | Susan E Gustafson | Nurse Practitioner | 634 Alpha Dr, Suite 600, Pittsburgh, PA 15238-2802 | 2009-05-06 |
| 1881872562 | Susan Gustafson | Recreation Therapist | 9600 Veterans Drive, Tacoma, WA 98493-0001 | 2008-02-05 |
| 1073657946 | Susan Irene Gustafson | Registered Nurse | 2640 Breslauer Way, Redding, CA 96001-4246 | 2007-02-16 |
| Street Address |
219 SE MAIN ST STE 400 |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55414-2151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720611148 | Marie Diaz | Psychologist | 219 Se Main St Ste 400, Minneapolis, MN 55414-2151 | 2020-02-13 |
| 1184108771 | Stephanie M Michaels | Psychologist | 219 Se Main St Ste 400, Minneapolis, MN 55414-2151 | 2018-09-19 |
| 1124541644 | Lisa Jennet Trump | Psychologist | 219 Se Main St Ste 400, Minneapolis, MN 55414-2151 | 2017-07-18 |
| 1265764641 | Matthew Johnson | Counselor | 219 Se Main St Ste 400, Minneapolis, MN 55414 | 2010-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407496516 | Liza N Meredith | Psychologist | Acacia Counseling and Wellness, 2724 University Ave Se Unit B, Minneapolis, MN 55414 | 2020-01-07 |
| 1346888732 | Danielle Lee Ann Vogler-bos | Naturopath | 575 Se 9th St, Suite #52, Minneapolis, MN 55414 | 2019-12-16 |
| 1164071148 | Amy C Moran | Psychologist | Acacia Counseling & Wellness, 2724 University Ave., Unit B, Minneapolis, MN 55414 | 2019-09-11 |
| 1346806585 | Kristen Bastug | Student in an Organized Health Care Education/Training Program | General Pediatrics and Adolescent Health, 1932k, 1717 Delaware Street Southeast, Suite 353, Minneapolis, MN 55414 | 2019-05-14 |
| 1053881698 | Lauren Michelle Scholder | Psychologist | 401 Main St Se Apt 7009, Minneapolis, MN 55414 | 2018-11-27 |
| 1427530666 | Kelli Howard | Psychologist | 2724 University Ave Se Unit B, Minneapolis, MN 55414 | 2018-09-04 |
| 1306370218 | Jiexiong Yang | Student in an Organized Health Care Education/Training Program | 814 Essex St Se, Minneapolis, MN 55414 | 2017-04-18 |
| 1598297699 | Patrick Curran | Student in an Organized Health Care Education/Training Program | 628 University Ave Se, Apt. 112, Minneapolis, MN 55414 | 2017-03-29 |
| 1679923957 | Jillian Theresa Tholen | Dietitian, Registered | 411 E Hennepin Ave, Minneapolis, MN 55414 | 2016-06-16 |
| 1073960290 | First Language Interpreter & Translation Services LLC | Interpreter | 2828 University Ave Se Suite 150, Minneapolis, MN 55414 | 2016-05-17 |
| Find all providers in zip 55414 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861008567 | Natalia V Potapova | Psychologist | 701 Park Ave # S1.110, Minneapolis, MN 55415-1623 | 2020-09-17 |
| 1962014167 | Kate Esterline | Psychologist | 2724 University Ave Se Ste B, Minneapolis, MN 55414-3210 | 2020-08-19 |
| 1831740216 | Seth Gordon Disner | Psychologist | 1 Veterans Dr # B68-2, Minneapolis, MN 55417-2309 | 2019-09-26 |
| 1366090763 | Healing Therapy LLC | Psychologist | 1813 S 6th St Ste 201, Minneapolis, MN 55454-1208 | 2019-08-28 |
| 1891340469 | Karin Fisher | Psychologist | 701 Park Ave # S1.260, Minneapolis, MN 55415-1623 | 2019-08-09 |
| 1053881698 | Lauren Michelle Scholder | Psychologist | 401 Main St Se Apt 7009, Minneapolis, MN 55414 | 2018-11-27 |
| 1902306038 | Ksa Psychological Services, LLC | Psychologist | 5603 Chicago Ave., Minneapolis, MN 55417 | 2018-02-15 |
| 1689030231 | Oliver Ross Psychology and Consulting LLC | Psychologist | 3802 Grand Ave S, Suite A, Minneapolis, MN 55409-1233 | 2016-01-13 |
| 1295100881 | Oliver Ross | Psychologist | 3802a Grand Avenue South, Minneapolis, MN 55409 | 2015-12-08 |
| 1841664190 | Lakes Wellness Center LLC | Psychologist | 3248 Stevens Ave, Minneapolis, MN 55408-3214 | 2015-11-24 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55414 |
Please comment or provide details below to improve the information on SUSAN GUSTAFSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.