Provider Demographics
NPI:1851515233
Name:STEINBRUECK, SUSAN MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:STEINBRUECK
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 1:5605 WASHINGTON AVE STE 8F
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4056
Mailing Address - Country:US
Mailing Address - Phone:262-977-0088
Mailing Address - Fax:262-753-6821
Practice Address - Street 1:5605 WASHINGTON AVE STE 8F
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4056
Practice Address - Country:US
Practice Address - Phone:262-977-0088
Practice Address - Fax:262-753-6821
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1703-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1703OtherLICENSE
11808707OtherCAQH
11808707OtherCAQH
1851515233OtherNPI