Provider Demographics
NPI:1699081489
Name:SIMPSON, SUSAN MELINDA (LICSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MELINDA
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MELINDA
Other - Last Name:SEIGWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE S.
Mailing Address - Street 2:F29 ADULT DAY TREATMENT
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-273-9115
Mailing Address - Fax:612-273-9110
Practice Address - Street 1:2450 RIVERSIDE AVE S.
Practice Address - Street 2:F29 ADULT DAY TREATMENT
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-9115
Practice Address - Fax:612-273-9110
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical