Provider Demographics
NPI:1568248599
Name:BROWN, SUSAN STEWART (HEALTH COACH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:STEWART
Last Name:BROWN
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:CALDWELL
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HEALTH COACH
Mailing Address - Street 1:6027 CANNON HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1822
Mailing Address - Country:US
Mailing Address - Phone:126-735-5375
Mailing Address - Fax:
Practice Address - Street 1:6027 CANNON HILL RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1822
Practice Address - Country:US
Practice Address - Phone:267-355-3758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach