MEDICARE: SUSAN MARIE GUENTHER PH D

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	103T00000X	Psychologist	00502	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821002213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE GUENTHER PH D

Provider Business Mailing Address
First Line	:	2800 RUTLAND AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-4014
Country	:	US
Telephone Number	:	515-279-0631
Fax Number	:	515-279-0631

Provider Business Practice Location Address
First Line	:	2800 RUTLAND AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50311-4014
Country	:	US
Telephone Number	:	515-279-0631
Fax Number	:	515-279-0631

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/11/2017

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Directions to “ SUSAN MARIE GUENTHER PH D” Practice Location

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