Provider Demographics
NPI:1831224047
Name:KORMAN, SUSAN KAY (LICSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:KORMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5707
Mailing Address - Country:US
Mailing Address - Phone:701-371-8915
Mailing Address - Fax:701-899-5965
Practice Address - Street 1:3523 45TH ST S STE 100
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8962
Practice Address - Country:US
Practice Address - Phone:701-347-1374
Practice Address - Fax:701-899-5965
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND31591041C0700X
MN81661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN154218400Medicaid
ND22024Medicare PIN
MN1831224047Medicare PIN