Provider Demographics
NPI:1568515823
Name:CONRAD, SUZANNE MARIE (EDS)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8826 LINEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5318
Mailing Address - Country:US
Mailing Address - Phone:727-444-3604
Mailing Address - Fax:727-372-5360
Practice Address - Street 1:8826 LINEBROOK DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5318
Practice Address - Country:US
Practice Address - Phone:727-444-3604
Practice Address - Fax:727-372-5360
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker