MEDICARE: MRS. SUSAN A DIETERICH LPCC

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	E0006694	OH

General Provider Information

NPI Number	:	1437171212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN A DIETERICH LPCC

Provider Business Mailing Address
First Line	:	31571 SCHWARTZ RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-3760
Country	:	US
Telephone Number	:	440-892-0452
Fax Number	:	440-892-3472

Provider Business Practice Location Address
First Line	:	24551 DETROIT RD
Second Line	:	STE 5
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2592
Country	:	US
Telephone Number	:	440-892-0452
Fax Number	:	440-892-3472

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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