Provider Demographics
NPI:1205926631
Name:JONES, SUSAN LAURIE (PSYD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LAURIE
Last Name:JONES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 30TH ST
Mailing Address - Street 2:#139
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1029
Mailing Address - Country:US
Mailing Address - Phone:303-448-4915
Mailing Address - Fax:303-444-2372
Practice Address - Street 1:2955 VALMONT RD.
Practice Address - Street 2:STE. 230
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-448-4915
Practice Address - Fax:303-444-2372
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1679103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist