Provider Demographics
NPI:1164638789
Name:DAISS, SUZANNE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:R
Last Name:DAISS
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 1:1030 N SAN FRANCISCO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3262
Mailing Address - Country:US
Mailing Address - Phone:928-774-1121
Mailing Address - Fax:
Practice Address - Street 1:1030 N SAN FRANCISCO ST STE 210
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3262
Practice Address - Country:US
Practice Address - Phone:928-774-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical