Provider Demographics
NPI:1861990012
Name:SUSAN MCPHERSON PHD ABPP LP LLC
Entity type:Organization
Organization Name:SUSAN MCPHERSON PHD ABPP LP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:952-746-4015
Mailing Address - Street 1:4805 DREW AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1741
Mailing Address - Country:US
Mailing Address - Phone:612-709-0589
Mailing Address - Fax:952-746-4015
Practice Address - Street 1:6550 YORK AVE S STE 419
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2335
Practice Address - Country:US
Practice Address - Phone:952-746-4014
Practice Address - Fax:952-746-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4457103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty