Provider Demographics
NPI:1073091492
Name:CRESSALL, SUZANNA (CSW)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:CRESSALL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6092
Mailing Address - Country:US
Mailing Address - Phone:801-298-2000
Mailing Address - Fax:
Practice Address - Street 1:880 S 650 E
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-3811
Practice Address - Country:US
Practice Address - Phone:801-318-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1050797235021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical