Provider Demographics
NPI:1376719534
Name:KRUPP, SUSAN BETH (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:KRUPP
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BETH KRUPP
Other - Last Name:ABELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LICSW
Mailing Address - Street 1:7515 WAYZATA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:952-767-5009
Mailing Address - Fax:952-920-5002
Practice Address - Street 1:7515 WAYZATA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:952-767-5009
Practice Address - Fax:952-920-5002
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical