Provider Demographics
NPI:1174283113
Name:NATYSIN, SUZANNE MARIA LEE CRAWFORD (LICSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIA LEE CRAWFORD
Last Name:NATYSIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARIA LEE
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1420 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3404
Mailing Address - Country:US
Mailing Address - Phone:651-428-1791
Mailing Address - Fax:
Practice Address - Street 1:900 LONG LAKE RD STE 160
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6414
Practice Address - Country:US
Practice Address - Phone:612-706-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN192141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical