Provider Demographics
NPI:1235263336
Name:POPE, SUZANNE (PHD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:POPE
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 1:528 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5002
Mailing Address - Country:US
Mailing Address - Phone:303-442-8320
Mailing Address - Fax:303-417-0700
Practice Address - Street 1:528 PEARL ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5002
Practice Address - Country:US
Practice Address - Phone:303-442-8320
Practice Address - Fax:303-417-0700
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 59103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist