Provider Demographics
NPI:1649225202
Name:STRICKLER, SUSAN REAGAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:REAGAN
Last Name:STRICKLER
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:PO BOX 31748
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-1748
Mailing Address - Country:US
Mailing Address - Phone:865-531-2714
Mailing Address - Fax:865-693-8250
Practice Address - Street 1:2060 LAKESIDE CENTRE WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6591
Practice Address - Country:US
Practice Address - Phone:865-531-2714
Practice Address - Fax:865-693-8250
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3689971Medicare ID - Type Unspecified