1609825934 NPI number — MRS. SUSAN DIANE REUSSER LCSW

Table of content: MRS. SUSAN DIANE REUSSER LCSW (NPI 1609825934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609825934 NPI number — MRS. SUSAN DIANE REUSSER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REUSSER
Provider First Name:
SUSAN
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
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:
REUSSER NEE TRICK
Provider Other First Name:
SUSAN
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609825934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 MEDICAL DRIVE SUITE 280
Provider Second Line Business Mailing Address:
STV HCS-HCHV BLUFFCREEK TOWERS
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-616-9915
Provider Business Mailing Address Fax Number:
210-616-9710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 LAKE AVE
Provider Second Line Business Practice Location Address:
VA-NIHCS
Provider Business Practice Location Address City Name:
FT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46805-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-426-5431
Provider Business Practice Location Address Fax Number:
260-460-1481
Provider Enumeration Date:
05/05/2006

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:  34003845A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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