Provider Demographics
NPI:1821125105
Name:VONFRAUSINGBORCH, SUSAN M
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:VONFRAUSINGBORCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 COUNTRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9626
Mailing Address - Country:US
Mailing Address - Phone:805-929-8129
Mailing Address - Fax:
Practice Address - Street 1:277 SOUTH STREET
Practice Address - Street 2:SUITE Y
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93406
Practice Address - Country:US
Practice Address - Phone:805-788-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health