Provider Demographics
NPI:1639946296
Name:NIENABER, SUSAN M R (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M R
Last Name:NIENABER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13040 BLUEBIRD ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-4031
Mailing Address - Country:US
Mailing Address - Phone:763-913-9505
Mailing Address - Fax:
Practice Address - Street 1:516 MISSION HOUSE LN
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-2571
Practice Address - Country:US
Practice Address - Phone:651-636-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist