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General NPI Number Information
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NPI Number | 1962111567
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Entity Type | Individual
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Provider Name | SUZANNE KLATT MSW, PHD, LISW-S
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Gender | Female
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 21 E STATE ST
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City | COLUMBUS
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State | OH
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Zip | 43215-4281
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Provider Business Mailing Address
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Address Line | 6823 CAMDEN COLLEGE CORNER RD
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City | COLLEGE CORNER
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State | OH
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Zip | 45003-9016
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Country | US
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Telephone | 513-839-5102
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.0600053-SUPV
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34010905A
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License Number State | IN
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