Provider Demographics
NPI:1558415216
Name:WALL, SUZANNE U (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:U
Last Name:WALL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SUZI
Other - Middle Name:U
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:15626 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1907
Mailing Address - Country:US
Mailing Address - Phone:602-526-2771
Mailing Address - Fax:480-484-5801
Practice Address - Street 1:7345 E EVANS RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3192
Practice Address - Country:US
Practice Address - Phone:602-526-2261
Practice Address - Fax:855-216-0664
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSW 36951041C0700X
AZLCSW 36951041S0200X
AZLCSW-36951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ591158Medicaid