Provider Demographics
NPI:1265561096
Name:ROCKERS-WITTKOPP, SUSAN MARIE (LSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:ROCKERS-WITTKOPP
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-5304
Mailing Address - Country:US
Mailing Address - Phone:507-433-6813
Mailing Address - Fax:
Practice Address - Street 1:308 4TH AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3140
Practice Address - Country:US
Practice Address - Phone:507-434-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10623104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker