Provider Demographics
NPI:1003944026
Name:BUSHFIELD, SUZANNE YOUNG (PHD,, MSW)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:YOUNG
Last Name:BUSHFIELD
Suffix:
Gender:F
Credentials:PHD,, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19835 N 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-0987
Mailing Address - Country:US
Mailing Address - Phone:602-543-6609
Mailing Address - Fax:602-543-6612
Practice Address - Street 1:4701 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4900
Practice Address - Country:US
Practice Address - Phone:602-543-6609
Practice Address - Fax:602-543-6612
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 11851041C0700X
AZBCD261221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical