Provider Demographics
NPI:1669630620
Name:WEIN, SUSAN J (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:WEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1268
Mailing Address - Country:US
Mailing Address - Phone:605-225-1774
Mailing Address - Fax:
Practice Address - Street 1:510 WILLOW DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1268
Practice Address - Country:US
Practice Address - Phone:605-225-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1462171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1462OtherSD BOARD OF SOCIAL WORK EXAMINERS