Provider Demographics
NPI:1154472561
Name:ECKFELDT, SUSAN MEDLICOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MEDLICOTT
Last Name:ECKFELDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:540 FAIRVIEW AVE N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1796
Mailing Address - Country:US
Mailing Address - Phone:651-210-8353
Mailing Address - Fax:651-952-0538
Practice Address - Street 1:540 FAIRVIEW AVE N
Practice Address - Street 2:SUITE 302
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1796
Practice Address - Country:US
Practice Address - Phone:651-210-8353
Practice Address - Fax:651-952-0538
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3045103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist