Provider Demographics
NPI:1639993827
Name:BOYSEN, SUZANNAH JOANNE (MA, LADC, LPCC)
Entity type:Individual
Prefix:
First Name:SUZANNAH
Middle Name:JOANNE
Last Name:BOYSEN
Suffix:
Gender:F
Credentials:MA, LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 PARK CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2504
Mailing Address - Country:US
Mailing Address - Phone:952-926-5626
Mailing Address - Fax:651-209-6341
Practice Address - Street 1:3705 PARK CENTER BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2504
Practice Address - Country:US
Practice Address - Phone:952-926-5626
Practice Address - Fax:651-209-6341
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305166101YA0400X
MN3318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)