Provider Demographics
NPI:1598813628
Name:ANSORGE, SUSAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:ANSORGE
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 1:3908 RIDGELEA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6127
Mailing Address - Country:US
Mailing Address - Phone:512-797-3654
Mailing Address - Fax:512-391-9021
Practice Address - Street 1:3908 RIDGELEA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6127
Practice Address - Country:US
Practice Address - Phone:512-797-3654
Practice Address - Fax:512-391-9021
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25813103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337652OtherVALUEOPTIONS
TX75GJOtherBLUE CROSS BLUE SHIELD