Provider Demographics
NPI:1235430653
Name:CAMPION, SUSAN (MS, LADC, NCGC-II)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CAMPION
Suffix:
Gender:F
Credentials:MS, LADC, NCGC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7570 147TH ST W
Mailing Address - Street 2:SUITE 307
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7560
Mailing Address - Country:US
Mailing Address - Phone:612-267-7952
Mailing Address - Fax:
Practice Address - Street 1:7570 147TH ST W
Practice Address - Street 2:SUITE 307
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7560
Practice Address - Country:US
Practice Address - Phone:612-267-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302633101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)