Provider Demographics
NPI:1548248701
Name:IWINSKI, SUSAN M (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:IWINSKI
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 LITTLE YORK RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2409
Mailing Address - Country:US
Mailing Address - Phone:937-454-0092
Mailing Address - Fax:937-264-1101
Practice Address - Street 1:28 E RAHN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5461
Practice Address - Country:US
Practice Address - Phone:937-454-0092
Practice Address - Fax:937-264-1101
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0000505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health