Provider Demographics
NPI:1942599386
Name:VANHATTEN, SUSAN KAY WIEGAND (LADC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY WIEGAND
Last Name:VANHATTEN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 CENTURY AVE S
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5206
Mailing Address - Country:US
Mailing Address - Phone:651-266-1443
Mailing Address - Fax:651-266-1468
Practice Address - Street 1:297 CENTURY AVE S
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55119-5206
Practice Address - Country:US
Practice Address - Phone:651-266-1443
Practice Address - Fax:651-266-1468
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302351101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)