MISS Susan Marie Back, MS LP

NPI #1609952027 in Jackson, Minnesota

Provider Information

NPI Number: 1609952027
Entity Type: Individual
Name: MISS Susan Marie Back, MS LP
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Psychologist
Credential: MS LP
Enumeration Date: Oct 27, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 116 COUNTY ROAD 34 W
City: Jackson
State: Minnesota
ZIP Code: 56143
Phone: (507) 847-5952

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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