Provider Demographics
NPI:1750858130
Name:ROOD, SUSAN EILEEN (EDD, MS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:EILEEN
Last Name:ROOD
Suffix:
Gender:F
Credentials:EDD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 WILLOW DR APT 94
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3584
Mailing Address - Country:US
Mailing Address - Phone:715-204-6755
Mailing Address - Fax:715-675-7238
Practice Address - Street 1:741 N 1ST ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403
Practice Address - Country:US
Practice Address - Phone:715-675-3458
Practice Address - Fax:715-675-7238
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4154-226104100000X
WI4154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker