Susan P Brokaw

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

0013 Issued in MN

Practice address

5100 Thimsen Ave
Suite 130
Minnetonka, MN 55345-4108

Phone

(952) 933-9926

Fax

(952) 474-3558

NPI assigned

May 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Susan Pye Brokaw Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356555346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 THIMSEN AVE",
            "address_2": "SUITE 130",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454108",
            "telephone_number": "952-933-9926",
            "fax_number": "952-474-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 THIMSEN AVE",
            "address_2": "SUITE 130",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454108",
            "telephone_number": "952-933-9926",
            "fax_number": "952-474-3558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROKAW",
        "first_name": "SUSAN",
        "middle_name": "P",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "0013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "ON289PY",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "BROKAW",
            "middle_name": "PYE",
            "prefix": "MRS.",
            "credential": "LMFT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Laura Jean Brinkmeier, PSYD, LP
• Wendy W. Britton, FNP-BC
• Laura Marie Brixius
• Sue Masiello Brock, APRN
• Beatrice J. Brogaard, SLP CCC
• Brookpark Markets LLC
• Wyatt Thomas Brooks, MHP, RBT
• Carol Lee Brown, MA, LMFT
• David Timothy Brown
• Eryn N Brown, PA-C

• Marriage & Family Therapist in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.