Provider Demographics
NPI:1356132260
Name:PETERSON, SUSAN THAYER (CPRS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:THAYER
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARY
Other - Last Name:THAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8044 MONTGOMERY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2919
Mailing Address - Country:US
Mailing Address - Phone:513-607-5128
Mailing Address - Fax:
Practice Address - Street 1:8044 MONTGOMERY RD STE 120
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2919
Practice Address - Country:US
Practice Address - Phone:513-607-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.002499175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist