Provider Demographics
NPI:1295715464
Name:PEARSON, SUSAN TEGGATZ (PHM)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:TEGGATZ
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1514
Mailing Address - Country:US
Mailing Address - Phone:215-579-7808
Mailing Address - Fax:
Practice Address - Street 1:289 N SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1514
Practice Address - Country:US
Practice Address - Phone:215-579-7808
Practice Address - Fax:610-294-9428
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006477L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000749160Medicare UPIN