Provider Demographics
NPI:1447784350
Name:STERRETT, SUZANNE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:STERRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1725
Mailing Address - Country:US
Mailing Address - Phone:406-532-9770
Mailing Address - Fax:406-541-3034
Practice Address - Street 1:1001 SW HIGGINS AVE
Practice Address - Street 2:STE 207
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1340
Practice Address - Country:US
Practice Address - Phone:406-532-9770
Practice Address - Fax:406-541-3034
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-232091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical