MEDICARE: MRS. ANNE-MARIE G. SUDDRETH LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0018820	CO

General Provider Information

NPI Number	:	1043288012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE-MARIE G. SUDDRETH LPCC

Provider Business Mailing Address
First Line	:	3507 RIVA RIDGE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6300
Country	:	US
Telephone Number	:	828-773-3659
Fax Number	:

Provider Business Practice Location Address
First Line	:	3507 RIVA RIDGE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6300
Country	:	US
Telephone Number	:	970-355-3420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	02/05/2024

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