Provider Demographics
NPI:1669566865
Name:DALLMAN, SUE ANNE
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANNE
Last Name:DALLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 WHITE BEAR PKWY
Mailing Address - Street 2:CENTER FOR HUMAN DEVELOPMENT
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3678
Mailing Address - Country:US
Mailing Address - Phone:651-426-8191
Mailing Address - Fax:651-426-6766
Practice Address - Street 1:4505 WHITE BEAR PKWY
Practice Address - Street 2:CENTER FOR HUMAN DEVELOPMENT
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3678
Practice Address - Country:US
Practice Address - Phone:651-426-8191
Practice Address - Fax:651-426-6766
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00588104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103080OtherUCARE