Individual
PAUL LYNN SUSIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
2451 EXECUTIVE DR. STE. 103, ST. CHARLES, MO 63303
(636) 300-9922
Mailing address
350 TRAILHEAD WAY, DARDENNE PRAIRIE, MO 63368
(636) 300-9922
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
01802
MO
Other
Enumeration date
07/24/2006
Last updated
07/08/2007
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