Provider Demographics
NPI:1669642229
Name:GRAHAM, SUSANNE WALKER (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:WALKER
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:E
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:808 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-7100
Mailing Address - Country:US
Mailing Address - Phone:574-534-0088
Mailing Address - Fax:574-971-8434
Practice Address - Street 1:808 N 3RD ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528
Practice Address - Country:US
Practice Address - Phone:574-534-0088
Practice Address - Fax:574-971-8434
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005937A1041C0700X
101Y00000X
FLSW181761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor