Provider Demographics
NPI:1043040256
Name:REICHARDT, SUZANNE M
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:REICHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 S CLARKSON ST APT 302
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2154
Mailing Address - Country:US
Mailing Address - Phone:781-752-7703
Mailing Address - Fax:
Practice Address - Street 1:8801 E HAMPDEN AVE STE 108
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4950
Practice Address - Country:US
Practice Address - Phone:720-504-6651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health