Provider Demographics
NPI:1992706642
Name:REEDER, SUSAN C (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:REEDER
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:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34451-0563
Mailing Address - Country:US
Mailing Address - Phone:352-344-2320
Mailing Address - Fax:352-344-4849
Practice Address - Street 1:480 PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-5746
Practice Address - Country:US
Practice Address - Phone:352-344-2320
Practice Address - Fax:352-344-4849
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR99776Medicare UPIN