1073756722 NPI number — SUZANNE SCHROCK-KELLEY MS, CGC

Table of content: SUZANNE SCHROCK-KELLEY MS, CGC (NPI 1073756722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073756722 NPI number — SUZANNE SCHROCK-KELLEY MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROCK-KELLEY
Provider First Name:
SUZANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073756722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2233 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81401-3831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-765-0818
Provider Business Mailing Address Fax Number:
970-497-8410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 S 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81401-5711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-497-8001
Provider Business Practice Location Address Fax Number:
970-240-7793
Provider Enumeration Date:
04/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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