Organization
SUSAN E NICOL PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN E NICOL PHD (CLINICAL PSYCHOLOGIST)
(952) 929-9478
Entity
Organization
Contact information
Practice address
4500 PARK GLEN RD, SUITE 270, ST LOUIS PARK, MN 55416-4871
(952) 929-9478
(952) 929-9548
Mailing address
4500 PARK GLEN RD, SUITE 270, ST LOUIS PARK, MN 55416-4871
(952) 929-9478
(952) 929-9548
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP0182
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424352800
—
MN
Enumeration date
06/05/2013
Last updated
06/05/2013
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