Healthcare Provider Details

I. General information

NPI: 1346366952
Provider Name (Legal Business Name): SUZANNE M STUTE MS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E OLIN AVE SUITE 100
MADISON WI
53713
US

IV. Provider business mailing address

128 E OLIN AVE SUITE 100
MADISON WI
53713
US

V. Phone/Fax

Practice location:
  • Phone: 608-252-1320
  • Fax: 608-252-1333
Mailing address:
  • Phone: 608-252-1320
  • Fax: 608-252-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3250125
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier43565800
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: