Provider Demographics
NPI:1659993517
Name:SUSZ, AUDREY LYNN
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LYNN
Last Name:SUSZ
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 1:6364 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3488
Mailing Address - Country:US
Mailing Address - Phone:234-380-3869
Mailing Address - Fax:
Practice Address - Street 1:3022 SAINT JOHN CT APT 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1819
Practice Address - Country:US
Practice Address - Phone:234-380-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services