Provider Demographics
NPI:1255479127
Name:SUSAN WELTNER-BRUNTON, PH.D., INC.
Entity Type:Organization
Organization Name:SUSAN WELTNER-BRUNTON, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WELTNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-754-7648
Mailing Address - Street 1:921 CHATHAM LN
Mailing Address - Street 2:SUITE 112
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2418
Mailing Address - Country:US
Mailing Address - Phone:614-754-7648
Mailing Address - Fax:614-754-7965
Practice Address - Street 1:921 CHATHAM LN
Practice Address - Street 2:SUITE 112
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2418
Practice Address - Country:US
Practice Address - Phone:614-754-7648
Practice Address - Fax:614-754-7965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4384103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH116400000OtherMAGELLAN