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Individual

SUSAN M JACQUEZ-DEAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D

Contact information

Practice address
1160 KEPLER DR, 2ND FLOOR, GREEN BAY, WI 54311-8321
(920) 288-5630
(920) 288-5439
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
(920) 288-4539

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
45956-020
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
34440300
WI
Enumeration date
08/31/2006
Last updated
07/01/2024
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