Provider Demographics
NPI:1710954086
Name:O'KOON, SUZANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANN
Middle Name:
Last Name:O'KOON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6491 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8847
Mailing Address - Country:US
Mailing Address - Phone:502-939-2987
Mailing Address - Fax:502-423-1599
Practice Address - Street 1:9812 SHELBYVILLE RD
Practice Address - Street 2:STE. 4
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2906
Practice Address - Country:US
Practice Address - Phone:502-939-2987
Practice Address - Fax:502-423-1599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1027103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60054OtherBLUE CROSS BLUE SHIELD