Provider Demographics
NPI:1861599755
Name:FEE, SUSAN DIANE (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANE
Last Name:FEE
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 ST LAWRENCE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SAFAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1175
Mailing Address - Country:US
Mailing Address - Phone:330-908-3840
Mailing Address - Fax:330-908-3841
Practice Address - Street 1:5475 LIBERTY AVENUE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089
Practice Address - Country:US
Practice Address - Phone:440-963-0402
Practice Address - Fax:440-963-4018
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0007857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health