Provider Demographics
NPI:1821002213
Name:GUENTHER, SUSAN MARIE (PH D)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:GUENTHER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:GUENTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D PC
Mailing Address - Street 1:2800 RUTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-4014
Mailing Address - Country:US
Mailing Address - Phone:515-279-0631
Mailing Address - Fax:515-279-0631
Practice Address - Street 1:2800 RUTLAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-4014
Practice Address - Country:US
Practice Address - Phone:515-279-0631
Practice Address - Fax:515-279-0631
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00502103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA099360000Medicaid