Provider Demographics
NPI:1194046524
Name:DENNY, SUSAN E (MS, CHT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:DENNY
Suffix:
Gender:F
Credentials:MS, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W HAYS ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5435
Mailing Address - Country:US
Mailing Address - Phone:208-546-1225
Mailing Address - Fax:208-344-1992
Practice Address - Street 1:1010 W HAYS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5435
Practice Address - Country:US
Practice Address - Phone:208-546-1225
Practice Address - Fax:208-344-1992
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1194046524Medicaid