Individual
SUSAN E. PERSONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LP
Contact information
Practice address
1000 LAKESHORE DR, MOOSE LAKE, MN 55767-9449
(218) 485-5419
Mailing address
1609 RIVER DR S, WABASHA, MN 55981-1768
(651) 565-0126
(651) 565-0126
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3599
MN
103TP2701X
Group Psychotherapy Psychologist
LP3599
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6280251000
—
MN
Enumeration date
11/07/2006
Last updated
07/23/2011
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