MEDICARE: MRS. SUSANNE HAIR LCSW

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	1041C0700X	Clinical Social Worker	32947	TX

General Provider Information

NPI Number	:	1336283738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSANNE HAIR LCSW

Provider Business Mailing Address
First Line	:	9604 PRESTON VINEYARD DR
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-8063
Country	:	US
Telephone Number	:	214-705-6804
Fax Number	:

Provider Business Practice Location Address
First Line	:	17430 CAMPBELL RD
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75252-5212
Country	:	US
Telephone Number	:	972-732-9555
Fax Number	:	972-250-6332

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

Provider Enumeration Date	:	02/18/2007
Last Update Date	:	07/08/2007

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