Provider Demographics
NPI:1568741593
Name:SEVENZ, SUSAN KAY (MS, CISW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:SEVENZ
Suffix:
Gender:F
Credentials:MS, CISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COTTONWOOD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2043
Mailing Address - Country:US
Mailing Address - Phone:262-367-2699
Mailing Address - Fax:262-367-5228
Practice Address - Street 1:300 COTTONWOOD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2043
Practice Address - Country:US
Practice Address - Phone:262-367-2699
Practice Address - Fax:262-367-5228
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI358-122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker