Individual
SAMANTHA SUSSEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
169 STARK ST, RANDOLPH, WI 53956-1298
(608) 423-6636
Mailing address
169 STARK ST, RANDOLPH, WI 53956-1298
(608) 423-6636
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9059-123
WI
Other
Enumeration date
05/31/2012
Last updated
09/15/2020
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