Healthcare Provider Details

I. General information

NPI: 1194800805
Provider Name (Legal Business Name): SUE A AMMEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11059 E BETHANY DR STE. 200
AURORA CO
80014-2622
US

IV. Provider business mailing address

11059 E BETHANY DR STE. 200
AURORA CO
80014-2622
US

V. Phone/Fax

Practice location:
  • Phone: 303-617-2457
  • Fax: 303-617-2475
Mailing address:
  • Phone: 303-617-2300
  • Fax: 303-617-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2936
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: