Provider Demographics
NPI:1730166315
Name:DEES, SUSAN (PSYD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DEES
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 1:24000 ROAD L
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-8806
Mailing Address - Country:US
Mailing Address - Phone:970-565-7588
Mailing Address - Fax:970-565-7588
Practice Address - Street 1:24000 ROAD L
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-8806
Practice Address - Country:US
Practice Address - Phone:970-565-7588
Practice Address - Fax:970-565-7588
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM658103T00000X
CO2353103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70902Medicaid
CO14378264Medicaid
AZ486888Medicaid
CO14378264Medicaid