Healthcare Provider Details

I. General information

NPI: 1114016425
Provider Name (Legal Business Name): SUSIE SUTTLE MPH,LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 N 2ND ST
MEMPHIS TN
38105-1632
US

IV. Provider business mailing address

534 N 2ND ST
MEMPHIS TN
38105-1632
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-1956
  • Fax:
Mailing address:
  • Phone: 901-448-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1649-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: