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General NPI Number Information
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NPI Number | 1447311055
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Entity Type | Individual
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Provider Name | SUSAN IRENE CHAMBERLAIN PHD
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 331 S 600 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-4013
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Country | US
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Telephone | 801-613-7305
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 GRANITE DR
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City | RENO
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State | NV
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Zip | 89509-3925
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Country | US
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Telephone | 812-325-3666
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Fax | 775-327-2293
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY1139
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 9307447-2501
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License Number State | UT
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