1518213339 NPI number — SUZANNE M. RABUSE LMFT

Table of content: SUZANNE M. RABUSE LMFT (NPI 1518213339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518213339 NPI number — SUZANNE M. RABUSE LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RABUSE
Provider First Name:
SUZANNE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RABUSE
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1518213339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1053 GRAND AVE STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55105-3074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-314-1890
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1053 GRAND AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55105-3074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-314-1890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2557 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)