Provider Demographics
NPI:1063297158
Name:KARTHEISER, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KARTHEISER
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 1:335 GABES RD
Mailing Address - Street 2:
Mailing Address - City:PAVILLION
Mailing Address - State:WY
Mailing Address - Zip Code:82523-9718
Mailing Address - Country:US
Mailing Address - Phone:847-951-0750
Mailing Address - Fax:
Practice Address - Street 1:335 GABES RD
Practice Address - Street 2:
Practice Address - City:PAVILLION
Practice Address - State:WY
Practice Address - Zip Code:82523-9718
Practice Address - Country:US
Practice Address - Phone:847-951-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator