Provider Demographics
NPI:1952967960
Name:SMART, SUZANNE (CASUDC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SMART
Suffix:
Gender:F
Credentials:CASUDC
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASUDC
Mailing Address - Street 1:164 E 5900 S STE 101
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7256
Mailing Address - Country:US
Mailing Address - Phone:801-261-5790
Mailing Address - Fax:801-261-5794
Practice Address - Street 1:164 E 5900 S STE 101
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7256
Practice Address - Country:US
Practice Address - Phone:801-261-5790
Practice Address - Fax:801-261-5794
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9567635-6018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)