MS. SUSAN A MEDO (NPI# 1174686216) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174686216 |
| Entity Type | Individual |
| Full Name | MS. SUSAN A MEDO |
| Credential | MA LP |
| Practice Address |
100 W Franklin Ave Minneapolis MN 55404-2433 |
| Mailing Address |
2530 1st Ave S #301 Minneapolis MN 55404-4341 |
| Practice Telephone | 6122038088 |
| Mailing Telephone | 6122038088 |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2008-10-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
LP3998 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 756187300 | 05 | |
| MN | BCBS | 210D4ME | 01 |
| Street Address |
100 W FRANKLIN AVE |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55404-2433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992052633 | Carise Marie Rotach-beard | Marriage & Family Therapist | 100 W Franklin Ave, Minneapolis, MN 55404-2433 | 2012-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568062461 | Andrew Moe | Counselor | 2118 Blaisdell Ave S., Minneapolis, MN 55404 | 2020-10-29 |
| 1194368191 | Luz Angelica Fehn Salinas | Psychologist | 1315 E24th St, Minneapolis, MN 55404 | 2019-10-22 |
| 1760969125 | Bethany Karen Kenny | Registered Nurse | 910 E 26th St Ste 200, Minneapolis, MN 55404 | 2018-07-27 |
| 1225535701 | Karissa Dougherty | Nurse Practitioner | 2200 E Franklin Ave # 199, Minneapolis, MN 55404 | 2018-04-10 |
| 1891299491 | Guidance Home Health Care LLC | Home Health | 2529 Nicollet Avenue 202b, Minneapolis, MN 55404 | 2018-03-20 |
| 1770085490 | Bright Future Counseling Service, LLC | Counselor | 912 E. 24th St., Suite B215, Minneapolis, MN 55404 | 2018-03-08 |
| 1346754298 | Juba Pharmacy Inc | Pharmacy | 1926 Chicago Ave S, Minneapolis, MN 55404 | 2017-11-29 |
| 1629597323 | Kira Larson Fieldstrom | Social Worker | 2400 Blaisdell Ave., Minneapolis, MN 55404 | 2017-09-13 |
| 1770008930 | Nicole Lynn Sparks | Social Worker | 2445 Park Avenue, Minneapolis, MN 55404 | 2017-08-09 |
| 1639612765 | Cosmo Home Healthcare Services, L.L.C. | Home Health | 2219 Oakland Ave S, Suite 104, Minneapolis, MN 55404 | 2016-11-21 |
| Find all providers in zip 55404 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801208566 | Rose Mary Boerboom | Psychologist | 415 N 1st St, #502, Minneapolis, MN 55401-4305 | 2014-05-28 |
| 1073826913 | Scott Michael Jacoby | Psychologist | 2110 Lyndale Ave S, Minneapolis, MN 55405-3196 | 2010-07-20 |
| 1447338702 | Eric Larsson | Psychologist | 2925 Dean Pkwy, Suite 300, Minneapolis, MN 55416-4470 | 2006-11-02 |
| 1417035551 | Jennifer Lynn Joseph | Psychologist | 3001 Broadway St Ne, Suite 185, Minneapolis, MN 55413-2195 | 2006-11-02 |
| 1942380316 | Janice L Ostrom | Psychologist | 4535 Washburn Ave N, Minneapolis, MN 55412-1055 | 2006-10-17 |
| 1740376268 | Debra Ann Stack | Psychologist | 2124 Dupont Avenue South #104, Minneapolis, MN 55403 | 2006-10-04 |
| 1194093641 | Kavita Mahesh Desai | Psychologist | 2545 Chicago Ave S, Suite 306, Mail Stop 17-306, Minneapolis, MN 55404-4543 | 2011-12-12 |
| 1649411406 | Meredith L. Gunlicks-stoessel | Psychologist | 2450 Riverside Ave, F256/2b West, Department of Psychiatry, Minneapolis, MN 55454-1450 | 2009-03-09 |
| 1114083540 | Brih Design LLC | Psychologist | 4535 Washburn Ave N, Minneapolis, MN 55412-1055 | 2006-12-29 |
| 1003987983 | Murray Joseph Mcallister | Psychologist | 800 E 28th St, Minneapolis, MN 55407-3723 | 2006-11-13 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55404 |
Please comment or provide details below to improve the information on MS. SUSAN A MEDO.
| 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.