MEDICARE: MRS. SUSAN MARIE DUDLEY

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
1	104100000X	Social Worker	LMSW-11366	AZ

General Provider Information

NPI Number	:	1528122132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN MARIE DUDLEY

Provider Business Mailing Address
First Line	:	9341 N CAMINO DEL PLATA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9070
Country	:	US
Telephone Number	:	520-797-9280
Fax Number	:

Provider Business Practice Location Address
First Line	:	6063 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2318
Country	:	US
Telephone Number	:	520-296-8255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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