Individual
MS. SUSAN A MEDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LP
Contact information
Practice address
100 W FRANKLIN AVE, MINNEAPOLIS, MN 55404-2433
(612) 203-8088
Mailing address
2530 1ST AVE S, #301, MINNEAPOLIS, MN 55404-4341
(612) 203-8088
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
LP3998
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
210D4ME
BCBS
MN
05
—
756187300
—
MN
Enumeration date
12/19/2006
Last updated
10/17/2008
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