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SAMANTHA SUSSEK
Clinical >> Social Worker >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1013278548
Individual Registrant: SAMANTHA SUSSEK
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
169 STARK ST RANDOLPH, WI 53956-1298 US
Tel: 608-423-6636 Fax: --
Tel: 608-423-6636 Fax: --
Contact information for business:
169 STARK ST RANDOLPH, WI 53956-1298 US
Tel: 608-423-6636 Fax: --
Tel: 608-423-6636 Fax: --
Registration Information:
NPI: 1013278548
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1041C0700X | Behavioral Health & Social Service Providers Social Worker Clinical | WI | 9059-123 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
