Provider Demographics
NPI:1003678939
Name:HOLDEN, SUSANNAH (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4983 W AMETHYST DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-2905
Mailing Address - Country:US
Mailing Address - Phone:801-660-7194
Mailing Address - Fax:
Practice Address - Street 1:4983 W AMETHYST DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-2905
Practice Address - Country:US
Practice Address - Phone:801-660-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6652876-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical