Provider Demographics
NPI:1811259039
Name:FREEMAN, SUSANNAH (LAC)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W KAGY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6052
Mailing Address - Country:US
Mailing Address - Phone:406-599-0088
Mailing Address - Fax:
Practice Address - Street 1:81 W KAGY BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6052
Practice Address - Country:US
Practice Address - Phone:406-599-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT8907-8OtherBLUE CROSS BLUE SHIELD