Provider Demographics
NPI:1750687679
Name:JAEGER, SUSAN DIANA (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANA
Last Name:JAEGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:DIANA
Other - Last Name:JAEGER-HINZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:155 N 1580 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-2067
Mailing Address - Country:US
Mailing Address - Phone:262-442-7557
Mailing Address - Fax:
Practice Address - Street 1:155 N 1580 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2067
Practice Address - Country:US
Practice Address - Phone:262-442-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12063101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor