Provider Demographics
NPI:1669555843
Name:ERICKSON, SUSAN LEE (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2497 7TH AVE E
Mailing Address - Street 2:BHSI LLC SUITE 101
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2496
Mailing Address - Country:US
Mailing Address - Phone:651-769-6437
Mailing Address - Fax:651-769-6426
Practice Address - Street 1:327 S MARSHALL RD
Practice Address - Street 2:BHSI LLC SUITE 250
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2666
Practice Address - Country:US
Practice Address - Phone:651-769-6500
Practice Address - Fax:651-769-6549
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-08-12
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Provider Licenses
StateLicense IDTaxonomies
MN371152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN695326300Medicaid
MN695326300Medicaid
MN260002342Medicare UPIN