Provider Demographics
NPI:1346363207
Name:DRURY, SUSANNE S (PHD)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:S
Last Name:DRURY
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 1:3023 E VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4435
Mailing Address - Country:US
Mailing Address - Phone:602-625-2852
Mailing Address - Fax:
Practice Address - Street 1:2737 E. GREENWAY BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4665
Practice Address - Country:US
Practice Address - Phone:602-625-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical