Provider Demographics
NPI:1255311056
Name:PIZITZ, SUSAN LYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYN
Last Name:PIZITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 W 4400 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-5644
Mailing Address - Country:US
Mailing Address - Phone:801-646-4710
Mailing Address - Fax:
Practice Address - Street 1:780 GUARDSMAN WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1374
Practice Address - Country:US
Practice Address - Phone:801-581-0194
Practice Address - Fax:801-581-0193
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT30859535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT071736OtherDESERET MUTUAL
UT942938348008OtherCHAMPUS
UT30859535000001OtherBLUE CROSS
UT107018468101OtherINTERMTN. HEALTH CARE