Provider Demographics
NPI:1578543393
Name:DOWNS, SUSAN MANLEY (MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MANLEY
Last Name:DOWNS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:AUDREY
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2853 S 1335 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3485
Mailing Address - Country:US
Mailing Address - Phone:443-794-1932
Mailing Address - Fax:
Practice Address - Street 1:320 S WAKARA WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1214
Practice Address - Country:US
Practice Address - Phone:801-584-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDABGC1996 #91564170300000X
UT8423541-3601170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS