Provider Demographics
NPI:1568501369
Name:SCHLISE, SUZANNE MARGARET (LVCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARGARET
Last Name:SCHLISE
Suffix:
Gender:F
Credentials:LVCSW
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:SCHLISE
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:917 S PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4138
Mailing Address - Country:US
Mailing Address - Phone:303-698-9463
Mailing Address - Fax:
Practice Address - Street 1:601 EMERSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3258
Practice Address - Country:US
Practice Address - Phone:303-698-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC09850361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC99196Medicare ID - Type Unspecified