Individual
MS. SUSAN MARIE BOURGERIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.P.
Contact information
Practice address
1409 WILLOW ST, SUITE 200, MINNEAPOLIS, MN 55403-2269
(612) 874-8608
(612) 874-8612
Mailing address
1409 WILLOW ST, SUITE 200, MINNEAPOLIS, MN 55403-2269
(612) 874-8608
(612) 874-8612
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 1735
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3K152BO
BCBS PROVIDER NUMBER
MN
Enumeration date
01/02/2007
Last updated
07/08/2007
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