Provider Demographics
NPI:1609086925
Name:BEMANN, SUSAN FEDYZKOWSKI (MS ART THERAPY)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FEDYZKOWSKI
Last Name:BEMANN
Suffix:
Gender:F
Credentials:MS ART THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213
Mailing Address - Country:US
Mailing Address - Phone:414-475-1844
Mailing Address - Fax:
Practice Address - Street 1:5151 W SILVER SPRING DR
Practice Address - Street 2:EWING A3
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218
Practice Address - Country:US
Practice Address - Phone:414-527-6970
Practice Address - Fax:414-527-6971
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43716700Medicaid