| Organization Name: | SUSANNAH DEVAULT |
| NPI Number: | 1134372741 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSANNAH DEVAULT (LICENSED CLINICAL SOCIAL WORKER) |
| Mailing Address: | 2639 Yeager Rd West Lafayette |
| State: | IN US |
| Postal Code: | 479061337 |
| Phone Number: | 7655320569 |
| Fax Number: | 7654979395 |
| NPI Enumeration Date: | 10/28/2008 |
| NPI Last Update Date: | 10/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 34005290A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |