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SAMANTHA SUSSEK

Clinical >> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1013278548

Individual Registrant:
 SAMANTHA  SUSSEK 
Gender: F
Sole Proprietor

Location and contact information for practice:
169 STARK ST  RANDOLPH, WI 53956-1298 US
Tel: 608-423-6636  Fax: --

Contact information for business:
169 STARK ST  RANDOLPH, WI 53956-1298 US
Tel: 608-423-6636  Fax: --

Registration Information:
NPI: 1013278548
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
WI9059-123

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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