Provider Demographics
NPI:1073983375
Name:PHILLIPS, SUZANNE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 SHOSHONE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1838
Mailing Address - Country:US
Mailing Address - Phone:704-975-2133
Mailing Address - Fax:
Practice Address - Street 1:200 UNION BLVD. STE. 200 , LAKEWOOD, CO. 80228
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80228
Practice Address - Country:US
Practice Address - Phone:303-406-1709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-40444103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst