Provider Demographics
NPI:1447585476
Name:KEIZER, SUZANNE MARIE (PSYD, MSCP)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:KEIZER
Suffix:
Gender:F
Credentials:PSYD, MSCP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:CLEVERINGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5612 S CAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2647
Mailing Address - Country:US
Mailing Address - Phone:712-266-5504
Mailing Address - Fax:
Practice Address - Street 1:1020 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4707
Practice Address - Country:US
Practice Address - Phone:605-444-9700
Practice Address - Fax:605-444-9701
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NE826103T00000X
IA000558103TH0100X
IA001195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001195OtherBOARD OF PSYCHOLOGY LICENSE
IA000558OtherIOWA HEALTH SERVICE PROVIDER
NE826OtherSTATE OF NEBRASKA
IA000558OtherIOWA HEALTH SERVICE PROVIDER
IA10041OtherCERTIFIED DRUG AND ALCOHOL COUNSELOR
IA111415188Medicaid
IA111415188Medicaid