Provider Demographics
NPI:1497946305
Name:KOTLER, SUSAN JACQUELINE (PHD, ABPP/ABCN)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JACQUELINE
Last Name:KOTLER
Suffix:
Gender:F
Credentials:PHD, ABPP/ABCN
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 1657
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-1657
Mailing Address - Country:US
Mailing Address - Phone:775-671-5080
Mailing Address - Fax:
Practice Address - Street 1:309 E JOHN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-3039
Practice Address - Country:US
Practice Address - Phone:775-671-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0533103G00000X, 103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical