Provider Demographics
NPI:1417243403
Name:SPRADLIN, SUZY JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZY
Middle Name:JOAN
Last Name:SPRADLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6656 COLTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2332
Mailing Address - Country:US
Mailing Address - Phone:510-339-9731
Mailing Address - Fax:
Practice Address - Street 1:6656 COLTON BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2332
Practice Address - Country:US
Practice Address - Phone:510-339-9731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5007174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist