Individual
SUSAN HAYDAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5471 W WATERFORD LN, APPLETON, WI 54913-8510
(920) 731-7445
Mailing address
5337 W GRANDE MARKET DR, APPLETON, WI 54913-8442
(920) 731-7445
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3665-57
WI
103TC0700X
Clinical Psychologist
9408
MA
103TC0700X
Clinical Psychologist
PSY24934
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GF591Z
PTAN
CA
01
—
W14158
GROUP PTAN
CA
01
—
ZZZ20041Z
GROUP PTAN
CA
Enumeration date
02/10/2012
Last updated
05/01/2019
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