Provider Demographics
NPI:1114016425
Name:SUTTLE, SUSIE (MPH,LMSW)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:SUTTLE
Suffix:
Gender:F
Credentials:MPH,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-1632
Mailing Address - Country:US
Mailing Address - Phone:901-448-1956
Mailing Address - Fax:
Practice Address - Street 1:534 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-1632
Practice Address - Country:US
Practice Address - Phone:901-448-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
AR1649-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker