Provider Demographics
NPI:1629057286
Name:BIRKNER-ANDERSON, SUSAN LENEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LENEE
Last Name:BIRKNER-ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:BIRKNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2723 DELSA DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2005
Mailing Address - Country:US
Mailing Address - Phone:801-272-7044
Mailing Address - Fax:
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-3176
Practice Address - Country:US
Practice Address - Phone:801-539-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT34680235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107032397101OtherINTRMTN. HEALTH CARE
UT942938348015OtherCHAMPUS
UT827404OtherDESERET MUTUAL
UT34680235000001OtherBLUE CROSS
UT107032397101OtherINTRMTN. HEALTH CARE