Provider Demographics
NPI:1861403099
Name:HOUTS, SUSAN L (LISW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:HOUTS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 28TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4400
Mailing Address - Country:US
Mailing Address - Phone:515-250-0140
Mailing Address - Fax:
Practice Address - Street 1:431 28TH ST STE 202
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4400
Practice Address - Country:US
Practice Address - Phone:515-250-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA062441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17046Medicare ID - Type Unspecified