Provider Demographics
NPI:1568784155
Name:BIELSTEIN, SUSAN RAE (SUSAN BIELSTEIN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAE
Last Name:BIELSTEIN
Suffix:
Gender:F
Credentials:SUSAN BIELSTEIN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:RAE
Other - Last Name:FARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUSAN BIELSTEIN
Mailing Address - Street 1:1620 E LINCOLN AVE LOT 55
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3860
Mailing Address - Country:US
Mailing Address - Phone:605-877-2660
Mailing Address - Fax:
Practice Address - Street 1:1620 E LINCOLN AVE LOT 55
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3860
Practice Address - Country:US
Practice Address - Phone:605-877-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management