Individual
MS. SUSAN B O'CONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
166 E GENEVA SQ, LAKE GENEVA, WI 53147-9694
(262) 278-6146
Mailing address
PO BOX 634, EAST TROY, WI 53120-0634
(262) 278-6146
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3011-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
391657985019
ANTHEM BLUE CROSS
WI
Enumeration date
10/11/2006
Last updated
11/14/2019
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