Provider Demographics
NPI:1043754195
Name:RATZBURG, SHANNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:
Last Name:RATZBURG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-0950
Mailing Address - Country:US
Mailing Address - Phone:814-632-8900
Mailing Address - Fax:
Practice Address - Street 1:6975 ROUTE 59
Practice Address - Street 2:
Practice Address - City:LEWIS RUN
Practice Address - State:PA
Practice Address - Zip Code:16738
Practice Address - Country:US
Practice Address - Phone:814-632-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3927103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical