Provider Demographics
NPI:1184775538
Name:SEARLE, SUSAN K (LICSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:SEARLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5661
Mailing Address - Country:US
Mailing Address - Phone:612-825-0786
Mailing Address - Fax:
Practice Address - Street 1:5009 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3041
Practice Address - Country:US
Practice Address - Phone:952-926-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN540101YM0800X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNPENDINGMedicare UPIN