Provider Demographics
NPI:1417914300
Name:GILL, SUSANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:
Last Name:GILL
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:PO BOX 46263
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53744-6263
Mailing Address - Country:US
Mailing Address - Phone:608-250-2492
Mailing Address - Fax:
Practice Address - Street 1:1122 FEATHER EDGE DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-7841
Practice Address - Country:US
Practice Address - Phone:608-250-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2388103T00000X
WI2388-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist