Provider Demographics
NPI:1558657411
Name:SUSNICK, ALLISON ANN (CSW 09923365)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANN
Last Name:SUSNICK
Suffix:
Gender:F
Credentials:CSW 09923365
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:ANN
Other - Last Name:RUUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW 09923365
Mailing Address - Street 1:1440 GROVE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2201
Mailing Address - Country:US
Mailing Address - Phone:303-504-1500
Mailing Address - Fax:
Practice Address - Street 1:1440 GROVE ST UNIT A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2201
Practice Address - Country:US
Practice Address - Phone:303-504-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099233651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical