Provider Demographics
NPI:1952111635
Name:PANCIERA, SUSAN ELISABETH KELLY
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELISABETH KELLY
Last Name:PANCIERA
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 1:918 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1451
Mailing Address - Country:US
Mailing Address - Phone:507-710-8763
Mailing Address - Fax:
Practice Address - Street 1:304 BELLE AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5250
Practice Address - Country:US
Practice Address - Phone:877-909-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical