Susan E Broadwell, MA.PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

11505 36TH Ave N
Plymouth, MN 55441-2304

Phone

(763) 509-3885

Fax

(763) 559-0149

NPI assigned

Mar 30, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740300078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11505 36TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412304",
            "telephone_number": "763-509-3885",
            "fax_number": "763-559-0149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11505 36TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412304",
            "telephone_number": "763-509-3885",
            "fax_number": "763-559-0149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWELL",
        "first_name": "SUSAN",
        "middle_name": "E",
        "credential": "MA.PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brent Cataldo DDS PA
• Courtney Caryl Breyer, MA, LADC, LPCC
• Jessica Bridgeford
• Brimhall Plymouth
• Vincent Alexander Brinker
• Kaylie Broberg
• Brookdale Senior Living Communities, Inc.
• Andrew Brooks, MD
• Kelly Lynn Brouwer, DPT
• Sharon Lynn Brouwer, MA CCC SLP

• All providers in Plymouth, MN
• Psychologist 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.