MEDICARE: DR. SUSAN E MCNEIL ED.D.

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	103TC0700X	Clinical Psychologist	5098	OH

General Provider Information

NPI Number	:	1881673366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN E MCNEIL ED.D.

Provider Business Mailing Address
First Line	:	5083 WHITE CHAPEL LN
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-7000
Country	:	US
Telephone Number	:	513-583-5409
Fax Number	:

Provider Business Practice Location Address
First Line	:	9200 MONTGOMERY RD
Second Line	:	STE. 13A
City	:	CINCINNATI
State	:	OH
Zip	:	45242-7789
Country	:	US
Telephone Number	:	513-791-8499
Fax Number	:	513-791-5895

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	10/18/2007

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