Provider Demographics
NPI:1033441340
Name:WEIRICK, SUSAN WILLIAMSON (NMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WILLIAMSON
Last Name:WEIRICK
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 S COUNTRY CLUB WAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4053
Mailing Address - Country:US
Mailing Address - Phone:480-820-5026
Mailing Address - Fax:
Practice Address - Street 1:3231 S COUNTRY CLUB WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4053
Practice Address - Country:US
Practice Address - Phone:480-820-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-1177175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath