Provider Demographics
NPI:1316292469
Name:KLEIN, SUSAN G (MS EDUCATION)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:G
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MS EDUCATION
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:G
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 WILSON ROAD
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:NY
Mailing Address - Zip Code:13625
Mailing Address - Country:US
Mailing Address - Phone:315-386-3061
Mailing Address - Fax:
Practice Address - Street 1:80 HIGHWAY 310 SUITE 2
Practice Address - Street 2:ST LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1476
Practice Address - Country:US
Practice Address - Phone:315-386-2325
Practice Address - Fax:315-386-2203
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist