Provider Demographics
NPI:1346365756
Name:STORTI, SUSAN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:STORTI
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 LILAC DR N STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4546
Mailing Address - Country:US
Mailing Address - Phone:763-545-7708
Mailing Address - Fax:763-545-3479
Practice Address - Street 1:1405 LILAC DR N STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55422-4546
Practice Address - Country:US
Practice Address - Phone:763-545-7708
Practice Address - Fax:763-545-3479
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2761103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist