Provider Demographics
NPI:1134205388
Name:GALL, SUSAN
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:GALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:GALL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8050 HOSBROOK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2994
Mailing Address - Country:US
Mailing Address - Phone:513-683-5043
Mailing Address - Fax:513-683-0069
Practice Address - Street 1:8050 HOSBROOK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2994
Practice Address - Country:US
Practice Address - Phone:513-683-5043
Practice Address - Fax:513-683-0069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0000831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional