Provider Demographics
NPI:1811246986
Name:HEGEDUS, SUSAN LEIGH (CSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEIGH
Last Name:HEGEDUS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 SUMAC CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2954
Mailing Address - Country:US
Mailing Address - Phone:414-659-6332
Mailing Address - Fax:
Practice Address - Street 1:1825 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1933
Practice Address - Country:US
Practice Address - Phone:414-298-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7334-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker