Provider Demographics
NPI:1871873703
Name:MONNENS, SUSAN M (LCMT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MONNENS
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8465 207TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8643
Mailing Address - Country:US
Mailing Address - Phone:952-380-7365
Mailing Address - Fax:
Practice Address - Street 1:8465 207TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8643
Practice Address - Country:US
Practice Address - Phone:952-380-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN946143OtherASSOCIATED BODYWORK & MASSAGE PROFESSIONALS