Provider Demographics
NPI:1053802397
Name:ISUROON
Entity type:Organization
Organization Name:ISUROON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-886-2731
Mailing Address - Street 1:1600 EAST LAKE STREET SUITE 1
Mailing Address - Street 2:MINNEAPOLIS
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-886-2731
Mailing Address - Fax:
Practice Address - Street 1:1600 EAST LAKE STREET SUITE 1
Practice Address - Street 2:MINNEAPOLIS
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-886-2731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty