MEDICARE: MS. SUZANNE JOY GOUDZWAARD PSYD

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	103TC0700X	Clinical Psychologist	0003955	CO

General Provider Information

NPI Number	:	1700168184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE JOY GOUDZWAARD PSYD

Provider Business Mailing Address
First Line	:	1801 I 70 BUSINESS LOOP STE B5
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-8002
Country	:	US
Telephone Number	:	970-245-3212
Fax Number	:	970-245-3216

Provider Business Practice Location Address
First Line	:	106 LOREY DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-7032
Country	:	US
Telephone Number	:	970-245-3212
Fax Number	:	970-245-3216

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

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	12/22/2021

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