Provider Demographics
NPI:1154304061
Name:STILLMAN, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6638 W OTTAWA AVE
Mailing Address - Street 2:SUITE 140-2
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4562
Mailing Address - Country:US
Mailing Address - Phone:303-972-6202
Mailing Address - Fax:303-972-6215
Practice Address - Street 1:6638 W OTTAWA AVE
Practice Address - Street 2:SUITE 140-2
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4562
Practice Address - Country:US
Practice Address - Phone:303-972-6202
Practice Address - Fax:303-972-6215
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9929851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical