Provider Demographics
NPI:1326248402
Name:SUCKOW, AMBER ROSE (ATC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:SUCKOW
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 NEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50630-9515
Mailing Address - Country:US
Mailing Address - Phone:480-751-8368
Mailing Address - Fax:
Practice Address - Street 1:2865 NEWELL AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:IA
Practice Address - Zip Code:50630-9515
Practice Address - Country:US
Practice Address - Phone:480-751-8368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer