Provider Demographics
NPI:1407912439
Name:MACQUIDDY, SUSAN LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:MACQUIDDY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:323 W DRAKE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-8115
Mailing Address - Country:US
Mailing Address - Phone:970-407-7223
Mailing Address - Fax:970-568-7191
Practice Address - Street 1:323 W DRAKE RD
Practice Address - Street 2:SUITE 124
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-8115
Practice Address - Country:US
Practice Address - Phone:970-407-7223
Practice Address - Fax:970-568-7191
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1143103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist