Provider Demographics
NPI:1447311055
Name:CHAMBERLAIN, SUSAN IRENE (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:IRENE
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3925
Mailing Address - Country:US
Mailing Address - Phone:812-325-3666
Mailing Address - Fax:775-327-2293
Practice Address - Street 1:331 S 600 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-4013
Practice Address - Country:US
Practice Address - Phone:801-613-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY1139103T00000X
UT9307447-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist