Provider Demographics
NPI:1891834966
Name:ANDERSON, SUSAN FERN (MALPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:FERN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MALPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10185 W TEXAS PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5054
Mailing Address - Country:US
Mailing Address - Phone:303-986-5026
Mailing Address - Fax:
Practice Address - Street 1:1978 S GARRISON ST
Practice Address - Street 2:SUITE 108
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-2282
Practice Address - Country:US
Practice Address - Phone:303-988-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional