Provider Demographics
NPI:1457421992
Name:MCVICKER, SUZAN A M (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:A M
Last Name:MCVICKER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 CHAMBERLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53726-3977
Mailing Address - Country:US
Mailing Address - Phone:608-255-9119
Mailing Address - Fax:608-255-9219
Practice Address - Street 1:122 E OLIN AVE STE 220
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1482
Practice Address - Country:US
Practice Address - Phone:608-255-9119
Practice Address - Fax:608-255-9219
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3334-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3334-125OtherLICENSED PROFESSIONAL COU