Provider Demographics
NPI:1275619421
Name:EPPLEY, SUSAN R (EDD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:EPPLEY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 HOSBROOK ROAD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236
Mailing Address - Country:US
Mailing Address - Phone:513-861-9797
Mailing Address - Fax:513-861-3510
Practice Address - Street 1:8040 HOSBROOK RD
Practice Address - Street 2:SUITE 320
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2901
Practice Address - Country:US
Practice Address - Phone:513-861-9797
Practice Address - Fax:513-861-3510
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2107103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP03643Medicare ID - Type Unspecified