Active NPI
Sue Anne Dallman
- Social Worker
- White Bear Lake, MN
National Provider Identifier
1669566865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 00588
- Practice address
- 4505 White Bear Pkwy
Center for Human Development
White Bear Lake, MN 55110-3678 - Phone
- (651) 426-8191
- Fax
- (651) 426-6766
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 00588 | MN | Primary |
Addresses
Primary practice location
4505 White Bear Pkwy
Center for Human Development
White Bear Lake, MN 55110-3678
Mailing address
4505 White Bear Pkwy
Center for Human Development
White Bear Lake, MN 55110-3678
Phone (651) 426-8191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103080 | Other | MN | UCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00588 | MN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669566865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4505 WHITE BEAR PKWY",
"address_2": "CENTER FOR HUMAN DEVELOPMENT",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551103678",
"telephone_number": "651-426-8191",
"fax_number": "651-426-6766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4505 WHITE BEAR PKWY",
"address_2": "CENTER FOR HUMAN DEVELOPMENT",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551103678",
"telephone_number": "651-426-8191",
"fax_number": "651-426-6766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALLMAN",
"first_name": "SUE",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MN",
"license": "00588",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "103080",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in White Bear Lake, MN
Sources for this page
- 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.