Healthcare Provider Details

I. General information

NPI: 1548384621
Provider Name (Legal Business Name): SUSANNE YOST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140S PARK BLVD
GREENWOOD IN
46143-8837
US

IV. Provider business mailing address

2256 WOODSWAY DR
GREENWOOD IN
46143-9564
US

V. Phone/Fax

Practice location:
  • Phone: 317-525-6220
  • Fax: 317-889-0836
Mailing address:
  • Phone: 317-887-1348
  • Fax: 317-882-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001389A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: