Provider Demographics
NPI:1659425213
Name:ASHTON, SUSAN SALLY (MSSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SALLY
Last Name:ASHTON
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:SALLY
Other - Last Name:KRYSZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW
Mailing Address - Street 1:1922 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-8221
Mailing Address - Country:US
Mailing Address - Phone:262-549-5153
Mailing Address - Fax:
Practice Address - Street 1:2100 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120-0621
Practice Address - Country:US
Practice Address - Phone:262-642-5080
Practice Address - Fax:262-643-4393
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10123103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10123OtherLICENSE NUMBER AS LCSW
WI39269800Medicaid