Provider Demographics
NPI:1376643957
Name:SCHULTZ, SUSAN K (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 OHMS LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2151
Mailing Address - Country:US
Mailing Address - Phone:952-842-0299
Mailing Address - Fax:
Practice Address - Street 1:7201 OHMS LN
Practice Address - Street 2:SUITE 220
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2151
Practice Address - Country:US
Practice Address - Phone:952-842-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0756103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent