Provider Demographics
NPI:1831379767
Name:CASSATT, SUSAN ELAINE (PHD, LP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:CASSATT
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:CASSATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1900 SILVER LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:5354 42ND ST S STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4032
Practice Address - Country:US
Practice Address - Phone:701-501-8014
Practice Address - Fax:701-941-4504
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4879103TC0700X
ND515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical