Provider Demographics
NPI:1861639007
Name:SCHLAG, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SCHLAG
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 1:18162 STILLWELL RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66052-4547
Mailing Address - Country:US
Mailing Address - Phone:619-517-5055
Mailing Address - Fax:
Practice Address - Street 1:655 DEEP VALLEY DR STE 220
Practice Address - Street 2:
Practice Address - City:RLLNG HLS EST
Practice Address - State:CA
Practice Address - Zip Code:90274-3661
Practice Address - Country:US
Practice Address - Phone:619-517-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT2880106H00000X
CAMFT52046106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist