| Doctor Name: | MS. SUSANNE ANNETTE SHORT |
| NPI Number: | 1639349020 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 14543 |
| Business Practice Address: | 1483 81st Ave Ne Spring Lake Park, MN - 554322111 |
| Business Phone Number: | 7637803036 |
| Business Fax Number: | |
| Mailing Address: | 1395 Arlington Ave W, SAINT PAUL |
| State: | MN |
| Postal Code: | 551082348 |
| Phone Number: | 6516442565 |
| Fax Number: | |
| NPI Enumeration Date: | 03/03/2008 |
| NPI Last Update Date: | 03/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 14543 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| 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 |