Provider Demographics
NPI:1669506606
Name:REED, SUSAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:SUE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 BEACH PLUM DR
Mailing Address - Street 2:
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064-1202
Mailing Address - Country:US
Mailing Address - Phone:207-934-5498
Mailing Address - Fax:
Practice Address - Street 1:778 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4109
Practice Address - Country:US
Practice Address - Phone:207-828-1799
Practice Address - Fax:207-828-1799
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC131171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist