Healthcare Provider Details

I. General information

NPI: 1750858130
Provider Name (Legal Business Name): SUSAN EILEEN ROOD ED.D, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 N 1ST ST
WAUSAU WI
54403
US

IV. Provider business mailing address

3550 WILLOW DR APT 94
PLOVER WI
54467-3584
US

V. Phone/Fax

Practice location:
  • Phone: 715-675-3458
  • Fax: 715-675-7238
Mailing address:
  • Phone: 715-204-6755
  • Fax: 715-675-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4154
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4154-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: