Provider Demographics
NPI:1932716347
Name:LUNDQUIST, SUSAN HELEN (BCTMB)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HELEN
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3954 HOMEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4507
Mailing Address - Country:US
Mailing Address - Phone:651-343-1165
Mailing Address - Fax:
Practice Address - Street 1:5901 OMAHA AVE N STE 115
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6477
Practice Address - Country:US
Practice Address - Phone:651-343-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist