Provider Demographics
NPI:1467691881
Name:KREULEN, SUSAN (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KREULEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LAKE ST N
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2523
Mailing Address - Country:US
Mailing Address - Phone:612-672-1514
Mailing Address - Fax:651-464-4847
Practice Address - Street 1:20 LAKE ST N
Practice Address - Street 2:SUITE 210
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2523
Practice Address - Country:US
Practice Address - Phone:612-672-1514
Practice Address - Fax:651-464-4847
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN205261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical