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General NPI Number Information
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NPI Number | 1790600476
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Entity Type | Individual
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Provider Name | SUZANNE BLUE
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Gender | Female
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 212 CHESTNUT ST
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City | MARYSVILLE
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State | OH
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Zip | 43040-1700
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Country | US
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Telephone | 937-578-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 212 CHESTNUT ST
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City | MARYSVILLE
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State | OH
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Zip | 43040-1700
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Country | US
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Telephone |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | LSP.01171
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License Number State | OH
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