Provider Demographics
NPI:1598026759
Name:DUCKWORTH, SUSAN (LGSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N 51ST AVE W
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2609
Mailing Address - Country:US
Mailing Address - Phone:218-464-0875
Mailing Address - Fax:
Practice Address - Street 1:215 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2402
Practice Address - Country:US
Practice Address - Phone:218-302-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21194104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker