Provider Demographics
NPI:1043389133
Name:GRUBB, SUSAN LOUISE (NCMT, CNMT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LOUISE
Last Name:GRUBB
Suffix:
Gender:F
Credentials:NCMT, CNMT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:LOUISE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCMT, CNMT
Mailing Address - Street 1:3489 W ALAMO PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2807
Mailing Address - Country:US
Mailing Address - Phone:303-798-2943
Mailing Address - Fax:
Practice Address - Street 1:3955 E EXPOSITION AVE STE 320
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5000
Practice Address - Country:US
Practice Address - Phone:303-777-1151
Practice Address - Fax:303-777-3112
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-1336921Medicare UPIN