Provider Demographics
NPI:1689979353
Name:SUSAN K KAHLE PHD LLC
Entity Type:Organization
Organization Name:SUSAN K KAHLE PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/ SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAHLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:937-901-3122
Mailing Address - Street 1:2600 FAR HILLS AVE
Mailing Address - Street 2:SUITE 321
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1687
Mailing Address - Country:US
Mailing Address - Phone:937-901-3122
Mailing Address - Fax:937-294-1470
Practice Address - Street 1:2600 FAR HILLS AVE
Practice Address - Street 2:SUITE 321
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1687
Practice Address - Country:US
Practice Address - Phone:937-901-3122
Practice Address - Fax:937-294-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5806103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty