| Doctor Name: | SUSAN E. PERSONS |
| NPI Number: | 1144399759 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, LP |
| License Number: | LP3599 |
| Business Practice Address: | 1000 Lakeshore Dr Moose Lake, MN - 557679449 |
| Business Phone Number: | 2184855419 |
| Business Fax Number: | |
| Mailing Address: | 1609 River Dr S, WABASHA |
| State: | MN |
| Postal Code: | 559811768 |
| Phone Number: | 6515650126 |
| Fax Number: | 6515650126 |
| NPI Enumeration Date: | 11/07/2006 |
| NPI Last Update Date: | 07/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TP2701X |
| License Number: | LP3599 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Group Psychotherapy |
| Taxonomy Definition: | |