Provider Demographics
NPI:1083991236
Name:BENNETT, SUSAN LESLIE (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LESLIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 HALE PKWY STE 380
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4023
Mailing Address - Country:US
Mailing Address - Phone:720-515-2140
Mailing Address - Fax:720-408-2541
Practice Address - Street 1:4700 HALE PKWY STE 380
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4023
Practice Address - Country:US
Practice Address - Phone:720-515-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3664103TH0004X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth