Provider Demographics
NPI:1902032840
Name:RICHARDS, SUSAN BETH (LISW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BETH
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 4TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1750
Mailing Address - Country:US
Mailing Address - Phone:712-234-0220
Mailing Address - Fax:712-234-0225
Practice Address - Street 1:600 4TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1750
Practice Address - Country:US
Practice Address - Phone:712-234-0220
Practice Address - Fax:712-234-0225
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06329OtherIA LICENSE