Individual
MRS. SUSAN P BROKAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5100 THIMSEN AVE, SUITE 130, MINNETONKA, MN 55345-4108
(952) 933-9926
(952) 474-3558
Mailing address
5100 THIMSEN AVE, SUITE 130, MINNETONKA, MN 55345-4108
(952) 933-9926
(952) 474-3558
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
0013
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ON289PY
BLUE CROSS BLUE SHIELD
MN
Enumeration date
05/09/2007
Last updated
07/08/2007
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