Provider Demographics
NPI:1871826651
Name:GADOL ANDERSON, SUZANNE LORI (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LORI
Last Name:GADOL ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17480 DALLAS PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7352
Mailing Address - Country:US
Mailing Address - Phone:214-552-9958
Mailing Address - Fax:
Practice Address - Street 1:17480 DALLAS PKWY STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7352
Practice Address - Country:US
Practice Address - Phone:214-552-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical