Provider Demographics
NPI:1639587280
Name:HASSERT, SUSI
Entity Type:Individual
Prefix:
First Name:SUSI
Middle Name:
Last Name:HASSERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 HUBBARD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3135
Mailing Address - Country:US
Mailing Address - Phone:608-831-4277
Mailing Address - Fax:608-831-8285
Practice Address - Street 1:7507 HUBBARD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3135
Practice Address - Country:US
Practice Address - Phone:608-831-4277
Practice Address - Fax:608-831-8285
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist