Provider Demographics
NPI:1154418770
Name:REEDY, SUSAN LYNN (BA / MHRS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:REEDY
Suffix:
Gender:F
Credentials:BA / MHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0400
Mailing Address - Country:US
Mailing Address - Phone:530-529-4013
Mailing Address - Fax:530-529-4002
Practice Address - Street 1:1445 VISTA WAY
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4510
Practice Address - Country:US
Practice Address - Phone:530-529-4013
Practice Address - Fax:530-529-4002
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00000171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator