Individual
NANCY MARIE CUSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
425 COON RAPIDS BLVD NW STE 200, SUITE 100, COON RAPIDS, MN 55433-2753
(763) 784-3008
Mailing address
4023 24TH AVE S, MINNEAPOLIS, MN 55406-3023
(612) 823-6578
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 3907
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201945100
—
MN
01
—
HP 37869
HEALTH PARTNERS
MN
Enumeration date
12/19/2006
Last updated
12/05/2011
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