Provider Demographics
NPI:1578697256
Name:MCDONALD-CONROY, SUSAN ANN (MS, MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANN
Last Name:MCDONALD-CONROY
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N12455 HUNTER LN
Mailing Address - Street 2:
Mailing Address - City:TREMPEALEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54661-7220
Mailing Address - Country:US
Mailing Address - Phone:608-534-6021
Mailing Address - Fax:
Practice Address - Street 1:200 MASON ST STE 11
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-7061
Practice Address - Country:US
Practice Address - Phone:608-769-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI758-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43712800Medicaid