Provider Demographics
NPI:1568417657
Name:ELEESON, SUSAN KRISTINE (PHD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KRISTINE
Last Name:ELEESON
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 1:47143 299TH ST
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-6702
Mailing Address - Country:US
Mailing Address - Phone:605-351-5826
Mailing Address - Fax:
Practice Address - Street 1:47143 299TH ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-6702
Practice Address - Country:US
Practice Address - Phone:605-351-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS100396Medicare PIN