Healthcare Provider Details

I. General information

NPI: 1659634178
Provider Name (Legal Business Name): SUSAN LEE WHITEHEAD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 GREENWAY BLVD STE 160
MIDDLETON WI
53562-3689
US

IV. Provider business mailing address

8215 GREENWAY BLVD STE 160
MIDDLETON WI
53562-3689
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax:
Mailing address:
  • Phone: 262-999-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4829-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: