Provider Demographics
NPI:1730131301
Name:FRANKLIN, SUZIE J (PHD)
Entity Type:Individual
Prefix:MS
First Name:SUZIE
Middle Name:J
Last Name:FRANKLIN
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 1:13800 W NORTH AVE
Mailing Address - Street 2:CHILD DEVELOPMENT CENTER OF CHW
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4977
Mailing Address - Country:US
Mailing Address - Phone:262-432-6600
Mailing Address - Fax:262-432-6604
Practice Address - Street 1:13800 W NORTH AVE
Practice Address - Street 2:CHILD DEVELOPMENT CENTER OF CHW
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4977
Practice Address - Country:US
Practice Address - Phone:262-432-6600
Practice Address - Fax:262-432-6604
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI564103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1730131301Medicaid
002000116KOtherHUMANA
002000116KOtherHUMANA
WI1730131301Medicaid
WI68086 0764Medicare PIN