Provider Demographics
NPI:1962092684
Name:HOWARD, SUSAN RAE (PARA-PROFESSIONAL)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PARA-PROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-4135
Mailing Address - Country:US
Mailing Address - Phone:937-266-1257
Mailing Address - Fax:
Practice Address - Street 1:2105 TITUS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-4135
Practice Address - Country:US
Practice Address - Phone:937-266-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0001819175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist