Healthcare Provider Details

I. General information

NPI: 1326939190
Provider Name (Legal Business Name): SUZANNE SKOTHEIM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 E 5TH ST
TUCSON AZ
85711-2005
US

IV. Provider business mailing address

4912 SUMMER RAIN DR
CONROE TX
77303-2254
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-0300
  • Fax:
Mailing address:
  • Phone: 520-444-4067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23070
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: