Provider Demographics
NPI:1538344668
Name:BLAISING, SUZANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:BLAISING
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 1:456 QUINBY ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4933
Mailing Address - Country:US
Mailing Address - Phone:312-944-3565
Mailing Address - Fax:
Practice Address - Street 1:2620 E PROSPECT RD STE 190
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9098
Practice Address - Country:US
Practice Address - Phone:312-944-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099278001041C0700X
CALCSW1034331041C0700X
FLSW184471041C0700X
IL1490091491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical