Provider Demographics
NPI:1922200419
Name:RAU FRITTS, SUSAN ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:RAU FRITTS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:RAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1421 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1668
Mailing Address - Country:US
Mailing Address - Phone:651-698-1791
Mailing Address - Fax:
Practice Address - Street 1:1165 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2615
Practice Address - Country:US
Practice Address - Phone:651-772-5555
Practice Address - Fax:651-772-5656
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN137391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical