Individual
MRS. SUSAN LEE POTTHAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC,LMT
Contact information
Practice address
14542 61ST AVE., BLUE GRASS, IA 52726-9592
(563) 381-4649
Mailing address
14542 61ST AVE., BLUE GRASS, IA 52726-9592
(563) 381-4649
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
01005
IA
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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