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General NPI Number Information
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NPI Number | 1629746805
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Entity Type | Individual
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Provider Name | MRS. SUSAN JOY VANDERBORGH
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Gender | Female
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 1455 DIXON AVE
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City | LAFAYETTE
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State | CO
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Zip | 80026-8879
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Country | US
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Telephone | 303-445-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 1802 SWEET CLOVER LN
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City | LOUISVILLE
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State | CO
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Zip | 80027-2431
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Country | US
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Telephone | 720-413-8348
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Fax | 720-307-4410
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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