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NPI Code Detail

MEDICARE: SUSAN IRENE CHAMBERLAIN PHD

MEDICARE: SUSAN IRENE CHAMBERLAIN PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPY1139NV
2103T00000XPsychologist9307447-2501UT

General Provider Information

NPI Number : 1447311055
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN IRENE CHAMBERLAIN PHD
Provider Business Mailing Address
First Line : 1355 GRANITE DR
Second Line :
City : RENO
State : NV
Zip : 89509-3925
Country : US
Telephone Number : 812-325-3666
Fax Number : 775-327-2293
Provider Business Practice Location Address
First Line : 331 S 600 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-4013
Country : US
Telephone Number : 801-613-7305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 09/30/2024

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