Provider Demographics
NPI:1215696901
Name:CARTER, SUSANNAH JANE (APSW)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:JANE
Last Name:CARTER
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 S 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3519
Mailing Address - Country:US
Mailing Address - Phone:414-828-4641
Mailing Address - Fax:
Practice Address - Street 1:1216 N 13TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2515
Practice Address - Country:US
Practice Address - Phone:414-430-7457
Practice Address - Fax:414-345-3248
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132423-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker