1710092960 NPI number — MS. SUSAN DOERFLINGER STURDEVANT LCSW

Table of content: MS. SUSAN DOERFLINGER STURDEVANT LCSW (NPI 1710092960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710092960 NPI number — MS. SUSAN DOERFLINGER STURDEVANT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STURDEVANT
Provider First Name:
SUSAN
Provider Middle Name:
DOERFLINGER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOERFLINGER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710092960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 W GLEN OAKS LN STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEQUON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53092-3369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-258-8314
Provider Business Mailing Address Fax Number:
414-270-1031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 W GLEN OAKS LN STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53092-3369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-258-8314
Provider Business Practice Location Address Fax Number:
414-270-1031
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6636-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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