Susan E. Persons, MS, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3599 Issued in MN

Practice address

1000 Lakeshore Dr
Moose Lake, MN 55767-9449

Phone

(218) 485-5419

NPI assigned

Nov 7, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311379200000",
    "number": "1144399759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 RIVER DR S",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559811768",
            "telephone_number": "651-565-0126",
            "fax_number": "651-565-0126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 LAKESHORE DR",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679449",
            "telephone_number": "218-485-5419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSONS",
        "first_name": "SUSAN",
        "middle_name": "E.",
        "credential": "MS, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2011-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3599",
            "primary": true
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MN",
            "license": "LP3599",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6280251000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northern Lakes Surgery Center LLC
• Northern Lakes Surgery Center LLC
• Dana Marie Osborne, M.A., LPCC, LICSW
• Keri Ann Ovsak, RN, MA, FNP-BC
• Leah Pederson, OTR/L
• Leann Poirier, OTR/L
• Barbara J. Reed, M.D.
• Randy J. Rice, M.D.
• Sonja M. Roach, N.P.
• James J. Ryan, M.D.

• Psychologist in Moose Lake, MN
• Providers in Moose Lake, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.