Provider Demographics
NPI:1689492662
Name:FRYER, SUSIE RENEE
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:RENEE
Last Name:FRYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 OLD MONROVIA RD NW APT 15214
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-5292
Mailing Address - Country:US
Mailing Address - Phone:334-531-3684
Mailing Address - Fax:
Practice Address - Street 1:4900 MERIDIAN ST N
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811
Practice Address - Country:US
Practice Address - Phone:256-372-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker