Provider Demographics
NPI:1245507706
Name:GOETTSCH, SUSAN MYERS (MED, LP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MYERS
Last Name:GOETTSCH
Suffix:
Gender:F
Credentials:MED, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:MAYO CLINIC - MAYO BLDG W-11
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-266-8086
Mailing Address - Fax:507-284-4158
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:MAYO CLINIC - MAYO BLDG W-11
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-266-8086
Practice Address - Fax:507-284-4158
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2853103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent