Provider Demographics
NPI:1619214046
Name:FLETCHER, SUSAN KAYE (TLMHC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAYE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 ASBURY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2848
Mailing Address - Country:US
Mailing Address - Phone:563-588-2227
Mailing Address - Fax:
Practice Address - Street 1:3435 ASBURY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2848
Practice Address - Country:US
Practice Address - Phone:563-588-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health