Provider Demographics
NPI:1407864515
Name:CANDELL, SUZANNE BETH (PHD, LP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BETH
Last Name:CANDELL
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 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 189S
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1052
Mailing Address - Country:US
Mailing Address - Phone:651-332-7474
Mailing Address - Fax:651-332-7475
Practice Address - Street 1:2550 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 189S
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1052
Practice Address - Country:US
Practice Address - Phone:651-332-7474
Practice Address - Fax:651-332-7475
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3830103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-71476OtherMEDICA
MN981231016105OtherPREFERRED ONE
MN266P0CAOtherBLUE CROSS