Provider Demographics
NPI:1417231432
Name:ROUNDY-SCHMIDT, SUZANNE L (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:ROUNDY-SCHMIDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S 103RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2526
Mailing Address - Country:US
Mailing Address - Phone:414-418-2835
Mailing Address - Fax:
Practice Address - Street 1:1439 92ND ST
Practice Address - Street 2:
Practice Address - City:FRANKSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53126-9710
Practice Address - Country:US
Practice Address - Phone:414-418-2835
Practice Address - Fax:414-509-1629
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7706-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical