Provider Demographics
NPI:1184214348
Name:ZUMWALT, SUZANNE MARIE (CERTIFIED FCT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:ZUMWALT
Suffix:
Gender:F
Credentials:CERTIFIED FCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41990 COOK ST STE 801A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6103
Mailing Address - Country:US
Mailing Address - Phone:442-666-3217
Mailing Address - Fax:760-616-7035
Practice Address - Street 1:41990 COOK ST STE 801A
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6103
Practice Address - Country:US
Practice Address - Phone:442-666-3217
Practice Address - Fax:760-616-7035
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAEDRLZNSVJIBWPFADM175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator