Healthcare Provider Details

I. General information

NPI: 1073433124
Provider Name (Legal Business Name): SUZANNE PARKER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E BROADWAY SUITE 203 1231
SALT LAKE CITY UT
84111
US

IV. Provider business mailing address

PO BOX 4139
PARK CITY UT
84060-4139
US

V. Phone/Fax

Practice location:
  • Phone: 801-448-6236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE PARKER
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 215-901-8232