Susan E Broadwell, MA.Psy.D.
Psychologist in Plymouth, MN. Individual provider (NPI-1).
NPI number1740300078
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1740300078
- Entity type
- Individual (NPI-1)
- Name
- Susan E Broadwell
- Credential
- MA.Psy.D.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 30, 2007
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | – | – | Yes |
Practice location
11505 36th Ave NPlymouth, MN 55441-2304
Phone 763-509-3885 · Fax 763-559-0149
Mailing address
11505 36th Ave NPlymouth, MN 55441-2304
Phone 763-509-3885 · Fax 763-559-0149
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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