Provider Demographics
NPI:1316118623
Name:REEDY, SUZANNE MARIE (LP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:REEDY
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6739 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4618
Mailing Address - Country:US
Mailing Address - Phone:763-544-1447
Mailing Address - Fax:763-544-0833
Practice Address - Street 1:6739 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4618
Practice Address - Country:US
Practice Address - Phone:763-544-1447
Practice Address - Fax:763-544-0833
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3357103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling