Provider Demographics
NPI:1083634513
Name:SUTER, PATSY (PHD)
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:
Last Name:SUTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 DETROIT AVE
Mailing Address - Street 2:STE C-1
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3766
Mailing Address - Country:US
Mailing Address - Phone:419-897-9757
Mailing Address - Fax:
Practice Address - Street 1:2340 DETROIT AVE
Practice Address - Street 2:STE C-1
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3766
Practice Address - Country:US
Practice Address - Phone:419-897-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5358103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2045325Medicaid
OH2045325Medicaid