Provider Demographics
NPI:1548639859
Name:KEA, SUSIE (BS FORENSIC BIOLOG)
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:KEA
Suffix:
Gender:F
Credentials:BS FORENSIC BIOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7844 MADISON AVE STE 152
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3540
Mailing Address - Country:US
Mailing Address - Phone:209-981-7545
Mailing Address - Fax:
Practice Address - Street 1:7844 MADISON AVE STE 152
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628
Practice Address - Country:US
Practice Address - Phone:209-981-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator