Basic Information
| Provider Information | |||||||||
| NPI: | 1699919050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONSON | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ROCHELLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 SANDHURST DR W | ||||||||
| Address2: | #216 | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551134697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126165654 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1821 UNIVERSITY AVE W | ||||||||
| Address2: | SUITE N-464 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551042801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516592900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2009 | ||||||||
| LastUpdateDate: | 04/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 13420 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.