Provider Demographics
NPI:1205050564
Name:MEDLIN, SUSAN KATHLEEN
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:MEDLIN
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 1:1340 ARNOLD DR.,
Mailing Address - Street 2:SUITE 200 CONTRA COSTA MENTAL HEALTH ADMINSTRATION
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553
Mailing Address - Country:US
Mailing Address - Phone:925-957-5104
Mailing Address - Fax:925-957-5156
Practice Address - Street 1:1340 ARNOLD DR.,
Practice Address - Street 2:SUITE 200 CONTRA COSTA MENTAL HEALTH ADMINISTRATION
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:925-957-5104
Practice Address - Fax:925-957-5156
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator