Provider Demographics
NPI:1316026776
Name:STALGAITIS, SUSAN JOAN (PHD IN CLIICAL PSYCH)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOAN
Last Name:STALGAITIS
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Gender:F
Credentials:PHD IN CLIICAL PSYCH
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Mailing Address - Street 1:9217 PARK WEST BLVD
Mailing Address - Street 2:STE D 1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4420
Mailing Address - Country:US
Mailing Address - Phone:865-691-2425
Mailing Address - Fax:865-531-8440
Practice Address - Street 1:9217 PARK WEST BLVD
Practice Address - Street 2:STE D 1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4420
Practice Address - Country:US
Practice Address - Phone:865-691-2425
Practice Address - Fax:865-531-8440
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TNTN967103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0034139Medicaid
TN0034139Medicaid