Provider Demographics
NPI:1922014604
Name:LEGRAND LEVINE, SUSAN JOAN (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOAN
Last Name:LEGRAND LEVINE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 HEARTLAND TRL STE 104
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-783-3165
Practice Address - Street 1:725 HEARTLAND TRL STE 104
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1976
Practice Address - Country:US
Practice Address - Phone:608-483-3428
Practice Address - Fax:888-783-3165
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2311-125101YP2500X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42224000Medicaid