Provider Demographics
NPI:1649247107
Name:HOWARD, SUSAN THERESA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:THERESA
Last Name:HOWARD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 EDWARDS ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-5634
Mailing Address - Country:US
Mailing Address - Phone:970-445-2489
Mailing Address - Fax:
Practice Address - Street 1:439 EDWARDS ACCESS RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5634
Practice Address - Country:US
Practice Address - Phone:970-445-2489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE192732084P0802X, 2084P0804X, 2084P0800X
CODR.00750512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025542700Medicaid
NE12006646OtherCAQH
NE24846OtherMIDLANDS
NE31593OtherBC/BS
NE527829OtherVALUE OPTIONS
NE738439000OtherMAGELLAN
NE31593OtherBC/BS