| Susan E Nicol Phd Llc | |
|
4500 Park Glen Rd Suite 270 St Louis Park MN 55416-4871 | |
| (952) 929-9478 | |
| (952) 929-9548 |
| Full Name | Susan E Nicol Phd Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 4500 Park Glen Rd, St Louis Park, Minnesota |
| Authorized Official Name and Position | Susan E Nicol (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 9529299478 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Susan E Nicol Phd Llc 4500 Park Glen Rd Suite 270 St Louis Park MN 55416-4871 Ph: (952) 929-9478 | Susan E Nicol Phd Llc 4500 Park Glen Rd Suite 270 St Louis Park MN 55416-4871 Ph: (952) 929-9478 |
| NPI Number | 1609214311 |
|---|---|
| Provider Enumeration Date | 06/05/2013 |
| Last Update Date | 06/05/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609214311 | NPI | - | NPPES |
| 424352800 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP0182 (Minnesota) | Primary |
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