Healthcare Provider Details

I. General information

NPI: 1487621629
Provider Name (Legal Business Name): SUSAN LOHNES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5236 VALDEZ CIR
DUGWAY UT
84022-1049
US

IV. Provider business mailing address

1650 COCHRANE CIR
FORT CARSON CO
80913-4603
US

V. Phone/Fax

Practice location:
  • Phone: 435-831-2618
  • Fax: 435-831-2459
Mailing address:
  • Phone: 719-526-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number350913-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: