Provider Demographics
NPI:1700196631
Name:YOUNG, SUSAN KAY (RD, CSO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RD, CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 MAIN AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4659
Mailing Address - Country:US
Mailing Address - Phone:970-946-0620
Mailing Address - Fax:970-422-1076
Practice Address - Street 1:2257 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4660
Practice Address - Country:US
Practice Address - Phone:970-946-0620
Practice Address - Fax:970-422-1076
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1024929133V00000X, 133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered