Individual
DR. SUSAN KOTTSCHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D., LP
Contact information
Practice address
375 ORLEANS ST E, STILLWATER, MN 55082-5830
(651) 430-2720
(651) 251-3155
Mailing address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(651) 777-5222
(651) 251-5111
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3512
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1032814
P1
MN
01
—
128655
UC
MN
01
—
255378
CP
MN
01
—
27164
HP
MN
01
—
334R0HI
BCBS
MN
01
—
61-52042
UBH
MN
Enumeration date
08/04/2006
Last updated
07/08/2007
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