MEDICARE: MS. SUSAN MARIE HAUSCH LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C2675	OR

General Provider Information

NPI Number	:	1033498506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MARIE HAUSCH LPC

Provider Business Mailing Address
First Line	:	PO BOX 765
Second Line	:
City	:	FAIRVIEW
State	:	OR
Zip	:	97024-0765
Country	:	US
Telephone Number	:	503-799-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	3915 SE STEELE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-4263
Country	:	US
Telephone Number	:	503-799-7666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	08/15/2011

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