Provider Demographics
NPI:1316733579
Name:JOSEPH, SUSAN ACKERMAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ACKERMAN
Last Name:JOSEPH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 WILKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1684
Mailing Address - Country:US
Mailing Address - Phone:323-547-4290
Mailing Address - Fax:
Practice Address - Street 1:5701 WILKINSON AVE
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1684
Practice Address - Country:US
Practice Address - Phone:323-547-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner