Provider Demographics
NPI:1477610277
Name:GAUGER, SUSAN RENEE (MSSW, ACSW, LISW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:GAUGER
Suffix:
Gender:F
Credentials:MSSW, ACSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 60TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-5118
Mailing Address - Country:US
Mailing Address - Phone:515-255-4027
Mailing Address - Fax:319-865-3110
Practice Address - Street 1:4900 UNIVERSITY AVE STE 210
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3342
Practice Address - Country:US
Practice Address - Phone:515-277-5989
Practice Address - Fax:515-277-6180
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001871041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1477610277Medicaid
IA421449693Medicaid