Suzanne M Hockley Murry
Individual provider Active NPI Psychologist · Baraboo, WI
NPI 1508083965 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508083965
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 2576-057 (WI)
- Practice address
- 505 Broadway St
Baraboo, WI 53913-2183 - Phone
- (608) 355-4200
- NPI assigned
- Apr 19, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2576-057 | WI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Sauk | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2576-057 | WI | Yes |
Addresses
Primary practice location
505 Broadway St
Baraboo, WI 53913-2183
Mailing address
1590 Honey Creek Cir
Plain, WI 53577-9784
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14398 | Other | WI | DEAN HEALTH PLAN |
| 396005740-39 | Other | WI | UNITY |
| 2020194 | Other | WI | PHYSICIANS PLUS |
| 39150600 | Medicaid | WI |
Other providers in Baraboo, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.