Provider Demographics
NPI:1891794855
Name:MCPHERSON, SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3209 WEST 76TH STREET #207
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5246
Mailing Address - Country:US
Mailing Address - Phone:952-746-4014
Mailing Address - Fax:952-746-4015
Practice Address - Street 1:3209 WEST 76TH STREET #207
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5246
Practice Address - Country:US
Practice Address - Phone:952-746-4014
Practice Address - Fax:952-746-4015
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4457103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist