| Doctor Name: | SUSAN MARGARET JACK |
| NPI Number: | 1083646343 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 47 |
| Business Practice Address: | 1660 Highway 100 South Parkdale Plaza, Suite 334 St. Louis Park, MN - 55416 |
| Business Phone Number: | 6123431616 |
| Business Fax Number: | 9527670228 |
| Mailing Address: | 1660 Highway 100 South, Parkdale Plaza, Suite 334 ST. LOUIS PARK |
| State: | MN |
| Postal Code: | 55416 |
| Phone Number: | 6123431616 |
| Fax Number: | 9527670228 |
| NPI Enumeration Date: | 07/07/2006 |
| NPI Last Update Date: | 02/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 47 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |