Provider Demographics
NPI:1083055636
Name:VAN VARK, SUZETTE KATHRYN (LMHC, IADC)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:KATHRYN
Last Name:VAN VARK
Suffix:
Gender:F
Credentials:LMHC, IADC
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:KATHRYN
Other - Last Name:DAWLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-0658
Mailing Address - Country:US
Mailing Address - Phone:641-683-6747
Mailing Address - Fax:
Practice Address - Street 1:310 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-683-6747
Practice Address - Fax:641-683-6317
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health