Provider Demographics
NPI:1306033550
Name:REBEDEAU, SUSAN MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:REBEDEAU
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:SCHLADER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:124 N. FEDERAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3201
Mailing Address - Country:US
Mailing Address - Phone:641-423-3864
Mailing Address - Fax:641-423-3836
Practice Address - Street 1:124 N. FEDERAL AVENUE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3201
Practice Address - Country:US
Practice Address - Phone:641-423-3864
Practice Address - Fax:641-423-3836
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA060601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43071OtherBLUE SHIELD/WELLMARK