Individual
REBECCA SUSAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
204 MISSISSIPPI AVE, RED WING, MN 55066-1807
(763) 689-5385
Mailing address
25075 ORLANDO AVE, CANNON FALLS, MN 55009-9155
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
2418
WI
235Z00000X
Speech-Language Pathologist
Primary
5443
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068R8SU
BCBS
MN
01
—
093K5SU
BCBS
MN
01
—
4600096
MEDICA
MN
01
—
HP45890
HEALTH PARTNERS
MN
Enumeration date
10/19/2006
Last updated
07/09/2007
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