Provider Demographics
NPI:1598722738
Name:DRENNAN, SUZANNE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:E
Last Name:DRENNAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 MINERAL POINT RD
Mailing Address - Street 2:STE 300
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1623
Mailing Address - Country:US
Mailing Address - Phone:608-833-9290
Mailing Address - Fax:608-833-9691
Practice Address - Street 1:7617 MINERAL POINT RD
Practice Address - Street 2:STE 300
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1623
Practice Address - Country:US
Practice Address - Phone:608-833-9290
Practice Address - Fax:608-833-9691
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2395 - 057103T00000X
WI2395-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10541OtherDEAN HEALTH PLAN
WI39248200Medicaid
WI999000306OtherWPS
WI39248200Medicaid