Active NPI
Susan Marie Bourgerie, M.A., L.P.
- Psychologist
- Minneapolis, MN
National Provider Identifier
1801953443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP 1735
- Practice address
- 1409 Willow St
Suite 200
Minneapolis, MN 55403-2269 - Phone
- (612) 874-8608
- Fax
- (612) 874-8612
- NPI assigned
- Jan 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP 1735 | MN | Primary |
Addresses
Primary practice location
1409 Willow St
Suite 200
Minneapolis, MN 55403-2269
Mailing address
1409 Willow St
Suite 200
Minneapolis, MN 55403-2269
Phone (612) 874-8608
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3K152BO | Other | MN | BCBS PROVIDER NUMBER |
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP 1735 | MN | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inner Outfitters, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Minneapolis, MN
- NPI 1790097327
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801953443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1409 WILLOW ST",
"address_2": "SUITE 200",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554032269",
"telephone_number": "612-874-8608",
"fax_number": "612-874-8612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1409 WILLOW ST",
"address_2": "SUITE 200",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554032269",
"telephone_number": "612-874-8608",
"fax_number": "612-874-8612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURGERIE",
"first_name": "SUSAN",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "M.A., L.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP 1735",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "3K152BO",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, 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.