Provider Demographics
NPI:1447280391
Name:NILSSON-WEISKOTT, SUSAN PATRICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PATRICIA
Last Name:NILSSON-WEISKOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:PATRICIA
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:826 WERNER WAY
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2963
Mailing Address - Country:US
Mailing Address - Phone:614-888-0749
Mailing Address - Fax:614-888-6773
Practice Address - Street 1:826 WERNER WAY
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2963
Practice Address - Country:US
Practice Address - Phone:614-888-0749
Practice Address - Fax:614-888-6773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2946103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNICP01071Medicare ID - Type Unspecified