Provider Demographics
NPI:1831972611
Name:OAKES, SUZANNAH E (APSW)
Entity type:Individual
Prefix:
First Name:SUZANNAH
Middle Name:E
Last Name:OAKES
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:SUZANNAH
Other - Middle Name:E
Other - Last Name:DAGNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW
Mailing Address - Street 1:50 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1541
Mailing Address - Country:US
Mailing Address - Phone:608-643-3147
Mailing Address - Fax:608-268-9780
Practice Address - Street 1:50 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1541
Practice Address - Country:US
Practice Address - Phone:608-643-3147
Practice Address - Fax:608-268-9780
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1341761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100248073Medicaid