Provider Demographics
NPI:1407023666
Name:LINKE, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LINKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1842
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-1842
Mailing Address - Country:US
Mailing Address - Phone:469-233-0710
Mailing Address - Fax:
Practice Address - Street 1:1400 PRESTON RD
Practice Address - Street 2:STE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5189
Practice Address - Country:US
Practice Address - Phone:469-233-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07691133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered