Provider Demographics
NPI:1194994483
Name:KAVKEWITZ, SUSAN PATE (LPE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PATE
Last Name:KAVKEWITZ
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 HERITAGE BUSINESS CT
Mailing Address - Street 2:SUITE 724
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7015
Mailing Address - Country:US
Mailing Address - Phone:423-622-2681
Mailing Address - Fax:423-855-8748
Practice Address - Street 1:6727 HERITAGE BUSINESS CT
Practice Address - Street 2:SUITE 724
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7015
Practice Address - Country:US
Practice Address - Phone:423-622-2681
Practice Address - Fax:423-855-8748
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1793103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral