Provider Demographics
NPI:1952509804
Name:STIFFLER, SUSAN DAWN (MED, CRC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DAWN
Last Name:STIFFLER
Suffix:
Gender:F
Credentials:MED, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 S. 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6228
Mailing Address - Country:US
Mailing Address - Phone:814-941-0822
Mailing Address - Fax:
Practice Address - Street 1:1608 S 12TH ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6228
Practice Address - Country:US
Practice Address - Phone:814-941-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC.R.C.# 00056114101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor