Healthcare Provider Details

I. General information

NPI: 1639640980
Provider Name (Legal Business Name): SUSAN MUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10945 REED HARTMAN HWY STE 302
BLUE ASH OH
45242-2852
US

IV. Provider business mailing address

6505 RIDGE CIR
CINCINNATI OH
45213-1045
US

V. Phone/Fax

Practice location:
  • Phone: 513-760-5979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1700287
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: