Healthcare Provider Details

I. General information

NPI: 1669424883
Provider Name (Legal Business Name): SUSAN MARY KRIESHOK OHLDE-ISBELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW GAGE BLVD
TOPEKA KS
66622-0001
US

IV. Provider business mailing address

5735 SW CLARION LAKES WAY
TOPEKA KS
66610-1625
US

V. Phone/Fax

Practice location:
  • Phone: 785-350-3111
  • Fax:
Mailing address:
  • Phone: 785-478-9308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY01504
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: