Provider Demographics
NPI:1811313927
Name:CONATSER, SUSAN
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:CONATSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 RUSTIC CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3200
Mailing Address - Country:US
Mailing Address - Phone:937-438-8336
Mailing Address - Fax:
Practice Address - Street 1:430 E PEASE AVE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1357
Practice Address - Country:US
Practice Address - Phone:937-859-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool