Provider Demographics
NPI:1346483997
Name:WARD, SUSIE L (MS,MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:L
Last Name:WARD
Suffix:
Gender:F
Credentials:MS,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 N 82ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4515
Mailing Address - Country:US
Mailing Address - Phone:414-257-5770
Mailing Address - Fax:
Practice Address - Street 1:2947 N MARTIN LUTHER KING DR STE 221
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2301
Practice Address - Country:US
Practice Address - Phone:414-265-4141
Practice Address - Fax:414-265-5149
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist