Provider Demographics
NPI:1902446271
Name:SUEDEL THERAPEUTICS PLLC
Entity Type:Organization
Organization Name:SUEDEL THERAPEUTICS PLLC
Other - Org Name:SUEDEL THERAPEUTICS & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:701-317-2897
Mailing Address - Street 1:1311 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5406
Mailing Address - Country:US
Mailing Address - Phone:701-317-2897
Mailing Address - Fax:701-213-4345
Practice Address - Street 1:3535 S 31ST ST STE 105
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3592
Practice Address - Country:US
Practice Address - Phone:701-317-2897
Practice Address - Fax:701-213-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDSUE78-1717OtherDRIVERS LICENSE