MISS SUSAN MARIE BACK (NPI# 1609952027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609952027 |
| Entity Type | Individual |
| Full Name | MISS SUSAN MARIE BACK |
| Credential | MS LP |
| Practice Address |
116 County Road 34 W Jackson MN 56143 |
| Mailing Address |
Po Box 245 116 County Road 34 W Jackson MN 56143 |
| Practice Telephone | 5078475952 |
| Practice Fax Number | 5078475275 |
| Mailing Telephone | 5078475952 |
| Mailing Fax Number | 5078475275 |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | LP1191 | MN | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902936669 | Susan J Back | Pediatrics | 3401 Civic Center Blvd, Children's Hospital of Philadelphia - Radiology, Philadelphia, PA 19104-4319 | 2007-03-06 |
| Street Address |
116 COUNTY ROAD 34 W |
| City | JACKSON |
| State | MN |
| Zip Code | 56143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063576965 | Jackson County Central Schools | Local Education Agency (LEA) | Jackson County Central Schools, 1128 North Highway, Jackson, MN 56143 | 2006-12-22 |
| 1992805204 | Kevin John Dunlavey | Dentist | 607 2nd St, Jackson, MN 56143 | 2006-09-25 |
| 1285978221 | Paul Anthony Roggow | Dentist | 604 Second Street, Jackson, MN 56143 | 2012-11-15 |
| 1083896716 | Shopko Stores Operating Co LLC | Pharmacy | 506 2nd St, Jackson, MN 56143 | 2007-12-05 |
| 1053456889 | Jackson Drug Co | Durable Medical Equipment & Medical Supplies | 506 2nd St, Jackson, MN 56143-0233 | 2007-02-20 |
| 1811915648 | Jackson Volunteer Ambulance | Ambulance | 305 Sheridan Str, Jackson, MN 56143-0242 | 2006-07-18 |
| 1750378758 | Sister Marie Paul Lockerd | Family Medicine | 803 4th St, Jackson, MN 56143-1056 | 2005-10-04 |
| 1407065824 | Desmoines Valley Bhs | Clinical Nurse Specialist | 803 4th St, Jackson, MN 56143-1056 | 2007-05-22 |
| 1942426689 | Margaret Jean Hart | Family Medicine | 803 4th St, Jackson, MN 56143-1056 | 2007-04-18 |
| 1003912171 | Sacred Heart Mercy Health Care Center | Family Medicine | 803 4th St, Jackson, MN 56143-1056 | 2006-09-16 |
| Find all providers in zip 56143 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144792169 | Snake River Consulting LLC | Psychologist | 430 Pine Dr, Jackson, WY 83001-8417 | 2019-01-02 |
| 1972834604 | Sue C Radtke | Psychologist | 4476 Bittersweet Ct, Jackson, WI 53037-9754 | 2010-01-20 |
| 1043549280 | University of Mississippi Medical Center | Psychologist | 2500 N State St # H819-01, Jackson, MS 39216-4500 | 2009-12-17 |
| 1356511562 | John Patterson Thorn | Psychologist | 270 Veronica Lane, Suite C-1, Jackson, WY 83001-0000 | 2008-03-04 |
| 1013109552 | Terri Martin Revelle | Psychologist | 111 E. Jefferson St., Jackson, NC 27845 | 2007-08-17 |
| 1184830143 | Toby S Altfeld | Psychologist | 156 C West University Parkway, Jackson, TN 38305 | 2007-05-15 |
| 1497968911 | Mollie Wyatt | Psychologist | 4055 I-55 North, Suite 293, Jackson, MS 39211 | 2007-05-08 |
| 1124249719 | John David Vickery | Psychologist | 3363 Highway 45 North, Jackson, TN 38305 | 2007-05-01 |
| 1215157425 | Angela O'briant Herzog | Psychologist | Forty-five Hundred Interstate Fifty-five North, Suite 208, Jackson, MS 39211 | 2007-04-27 |
| 1295877165 | Rose Margaret Hochheiser | Psychologist | 140 King Street, Jackson, WY 83001 | 2007-02-13 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.