Susan E Nicol PHD LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP0182 Issued in MN

Legal business name

SUSAN E NICOL PHD LLC

Practice address

4500 Park Glen Rd
Suite 270
St Louis Park, MN 55416-4871

Phone

(952) 929-9478

Fax

(952) 929-9548

NPI assigned

Jun 5, 2013

Organization subpart

No

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

Authorized official

Name

Susan E Nicol, PHD

Title

Clinical Psychologist

Phone

(952) 929-9478

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370390400000",
    "number": "1609214311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 PARK GLEN RD",
            "address_2": "SUITE 270",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164871",
            "telephone_number": "952-929-9478",
            "fax_number": "952-929-9548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 PARK GLEN RD",
            "address_2": "SUITE 270",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164871",
            "telephone_number": "952-929-9478",
            "fax_number": "952-929-9548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN E NICOL PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-05",
        "last_updated": "2013-06-05",
        "status": "A",
        "authorized_official_last_name": "NICOL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "952-929-9478",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP0182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "424352800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; 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.