Provider Demographics
NPI:1093886574
Name:GOLDEN, SUZANNE S (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:S
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 PROSPECTOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4806
Mailing Address - Country:US
Mailing Address - Phone:636-458-8777
Mailing Address - Fax:636-273-1244
Practice Address - Street 1:549 PROSPECTOR RIDGE DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63011-4806
Practice Address - Country:US
Practice Address - Phone:636-458-8777
Practice Address - Fax:636-273-1244
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist