Healthcare Provider Details

I. General information

NPI: 1376671545
Provider Name (Legal Business Name): SUSAN L HEWGLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25850 MAIN ST
ARDMORE TN
38449-3156
US

IV. Provider business mailing address

25850 MAIN ST
ARDMORE TN
38449-3156
US

V. Phone/Fax

Practice location:
  • Phone: 931-427-6052
  • Fax: 931-427-6053
Mailing address:
  • Phone: 931-427-6052
  • Fax: 931-427-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5485
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: