Provider Demographics
NPI:1881460137
Name:SCHOSSOW, BRALEIGH SUSAN
Entity type:Individual
Prefix:MISS
First Name:BRALEIGH
Middle Name:SUSAN
Last Name:SCHOSSOW
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 1:2057 220TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-8594
Mailing Address - Country:US
Mailing Address - Phone:712-371-9399
Mailing Address - Fax:
Practice Address - Street 1:142 N 9TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3911
Practice Address - Country:US
Practice Address - Phone:515-293-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician