Provider Demographics
NPI:1245736479
Name:HEDGES, SUSAN JILL (LPCC, LPAT, RPT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JILL
Last Name:HEDGES
Suffix:
Gender:F
Credentials:LPCC, LPAT, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ARCTIC SPGS
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4701
Mailing Address - Country:US
Mailing Address - Phone:502-727-9854
Mailing Address - Fax:
Practice Address - Street 1:36 ARCTIC SPGS
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4701
Practice Address - Country:US
Practice Address - Phone:502-727-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY323751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health