Healthcare Provider Details

I. General information

NPI: 1619889854
Provider Name (Legal Business Name): CHRISTINE ANN SUSK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 FLEUR DR
DES MOINES IA
50321-1756
US

IV. Provider business mailing address

1621 9TH ST APT 12
DES MOINES IA
50314-2848
US

V. Phone/Fax

Practice location:
  • Phone: 515-257-6825
  • Fax:
Mailing address:
  • Phone: 609-435-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-01660
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: