Provider Demographics
NPI:1568450633
Name:WHITTEN, SUSAN E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:WHITTEN-HOGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4860 ROBB ST
Mailing Address - Street 2:STE 201
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2162
Mailing Address - Country:US
Mailing Address - Phone:888-948-6789
Mailing Address - Fax:
Practice Address - Street 1:13050 PARKSIDE DR
Practice Address - Street 2:SUITE 240
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-8235
Practice Address - Country:US
Practice Address - Phone:317-621-1100
Practice Address - Fax:317-621-1000
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003850A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN179200CMedicare ID - Type Unspecified