Provider Demographics
NPI:1033382593
Name:MONDA, SUZANNE A (MSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:A
Last Name:MONDA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 N FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1653
Mailing Address - Country:US
Mailing Address - Phone:414-961-2070
Mailing Address - Fax:
Practice Address - Street 1:104 W LINDEN DR STE A
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-2801
Practice Address - Country:US
Practice Address - Phone:920-674-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI435554001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical