Provider Demographics
NPI:1417746876
Name:ROBERTS, SUSAN ANN (MS, PPS, PPSP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:
Credentials:MS, PPS, PPSP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:426 N BLACKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4449
Mailing Address - Country:US
Mailing Address - Phone:559-656-5482
Mailing Address - Fax:
Practice Address - Street 1:426 N BLACKSTONE ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4449
Practice Address - Country:US
Practice Address - Phone:559-656-5482
Practice Address - Fax:559-687-7317
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230256220103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool