Provider Demographics
NPI:1053715086
Name:BRANNAN, SUZANNE THERESA (BS, LADC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:THERESA
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:BS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3222
Mailing Address - Country:US
Mailing Address - Phone:763-464-0229
Mailing Address - Fax:
Practice Address - Street 1:797 EAST 7TH ST.
Practice Address - Street 2:CLUES CHEMICAL HEALTH
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106
Practice Address - Country:US
Practice Address - Phone:651-379-4287
Practice Address - Fax:651-379-4297
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303996101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)