Provider Demographics
NPI:1427139526
Name:PHILLIPS, SUSAN KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1107
Mailing Address - Country:US
Mailing Address - Phone:608-288-8022
Mailing Address - Fax:608-288-8977
Practice Address - Street 1:6333 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1107
Practice Address - Country:US
Practice Address - Phone:608-288-8022
Practice Address - Fax:608-288-8977
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional