MEDICARE: MS. SUSAN J HASSED MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1669460549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN J HASSED MS

Provider Business Mailing Address
First Line	:	940 NE 13TH ST
Second Line	:	CHO - GENETICS 2B 2418
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5008
Country	:	US
Telephone Number	:	405-271-8685
Fax Number	:	405-271-8697

Provider Business Practice Location Address
First Line	:	940 NE 13TH ST
Second Line	:	CHO - GENETICS 2B 2418
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5008
Country	:	US
Telephone Number	:	405-271-8685
Fax Number	:	405-271-8697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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