Provider Demographics
NPI:1396914602
Name:WESTERLIND, SUSAN (PSY D, LP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WESTERLIND
Suffix:
Gender:F
Credentials:PSY D, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 2ND ST. S.
Mailing Address - Street 2:STE 301
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1314
Mailing Address - Country:US
Mailing Address - Phone:320-252-2976
Mailing Address - Fax:320-656-1570
Practice Address - Street 1:110 2ND ST. S.
Practice Address - Street 2:STE 301
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1314
Practice Address - Country:US
Practice Address - Phone:320-252-2976
Practice Address - Fax:320-656-1570
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN468462000Medicaid
MNLP4889OtherLICENSE
MNLP4889OtherLICENSE