Healthcare Provider Details

I. General information

NPI: 1669523312
Provider Name (Legal Business Name): SUSAN DENISE DUENKE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 MAIN ST PO BOX 895
MURPHYS CA
95247-9625
US

IV. Provider business mailing address

PO BOX 895
MURPHYS CA
95247-0895
US

V. Phone/Fax

Practice location:
  • Phone: 209-743-5001
  • Fax:
Mailing address:
  • Phone: 209-743-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: