Provider Demographics
NPI:1396869392
Name:WALCZAK, SUSAN MACLEAN (MS CNIM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MACLEAN
Last Name:WALCZAK
Suffix:
Gender:F
Credentials:MS CNIM
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:MACLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9154 W PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-8121
Mailing Address - Country:US
Mailing Address - Phone:303-904-0618
Mailing Address - Fax:303-904-0618
Practice Address - Street 1:14140 FAIRWAY LN
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-9564
Practice Address - Country:US
Practice Address - Phone:303-425-3213
Practice Address - Fax:303-466-9772
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist