Provider Demographics
NPI:1003832932
Name:DAY, SUSAN K (CP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:DAY
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W FRONT ST
Mailing Address - Street 2:STE 309
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4011
Mailing Address - Country:US
Mailing Address - Phone:406-327-9992
Mailing Address - Fax:406-327-9987
Practice Address - Street 1:119 W FRONT ST
Practice Address - Street 2:STE 309
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4011
Practice Address - Country:US
Practice Address - Phone:406-327-9992
Practice Address - Fax:406-327-9987
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT347103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00126297OtherRAILROAD MEDICARE
MT0492065Medicaid
MT0492065Medicaid