Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS016525 | PA |
N | 103T00000X | Psychologist | PS016525 | PA |
Y | 103G00000X | Clinical Psychologist | PS016525 | PA |
Y | 103TC0700X | Clinical Psychologist | PS016525 | PA |
NPI | 1003056144 |
---|---|
Provider Name | Susan Lynn Calhoun |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2009 |
Last Update Date | 08/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023722130001 | (05) | PA |
PS016525 | MEDICAL LICENSE (01) | PA |