Provider Demographics
NPI:1316417678
Name:LEDEE-RANDALL, SUSAN S (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:LEDEE-RANDALL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 BAKER LN STE 3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5445
Mailing Address - Country:US
Mailing Address - Phone:775-870-8555
Mailing Address - Fax:
Practice Address - Street 1:3773 BAKER LN STE 3
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5445
Practice Address - Country:US
Practice Address - Phone:775-870-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL135741041C0700X
NV9167-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical