Provider Demographics
NPI:1063729093
Name:FAILEY, SUSAN A (MSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:FAILEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2165
Mailing Address - Country:US
Mailing Address - Phone:812-333-6324
Mailing Address - Fax:
Practice Address - Street 1:550 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2165
Practice Address - Country:US
Practice Address - Phone:812-333-6324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical