Provider Demographics
NPI:1568666105
Name:MCCALLUM, SUSAN JOY (MA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JOY
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20735 SAINT FRANCIS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9667
Mailing Address - Country:US
Mailing Address - Phone:763-753-9542
Mailing Address - Fax:
Practice Address - Street 1:20735 SAINT FRANCIS BLVD
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-9667
Practice Address - Country:US
Practice Address - Phone:763-753-9542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health