Provider Demographics
NPI:1346599917
Name:WOOLEVER, SUSAN M (MA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WOOLEVER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 6TH AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2381
Mailing Address - Country:US
Mailing Address - Phone:312-363-8142
Mailing Address - Fax:
Practice Address - Street 1:412 6TH AVE APT 12
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2381
Practice Address - Country:US
Practice Address - Phone:312-363-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001469101YM0800X
IL180007368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional