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General NPI Number Information
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NPI Number | 1033382593
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Entity Type | Individual
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Provider Name | SUZANNE A MONDA MSW
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Gender | Female
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 104 W LINDEN DR STE A
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City | JEFFERSON
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State | WI
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Zip | 53549-2801
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Country | US
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Telephone | 920-674-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 4477 N FREDERICK AVE
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City | SHOREWOOD
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State | WI
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Zip | 53211-1653
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Country | US
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Telephone | 414-961-2070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 43555400
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License Number State | WI
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