Provider Demographics
NPI:1265500755
Name:BOLLINGER BROWN, SUSAN J
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:BOLLINGER BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 DODD RD
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1113
Mailing Address - Country:US
Mailing Address - Phone:651-450-2220
Mailing Address - Fax:651-450-2221
Practice Address - Street 1:1025 DODD RD
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1113
Practice Address - Country:US
Practice Address - Phone:651-450-2220
Practice Address - Fax:651-450-2221
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN130611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical