Provider Demographics
NPI:1487951315
Name:BUEKER, SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BUEKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12395
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-2395
Mailing Address - Country:US
Mailing Address - Phone:623-521-5446
Mailing Address - Fax:623-334-6724
Practice Address - Street 1:18001 N 79TH AVE
Practice Address - Street 2:SUITE B-45
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8388
Practice Address - Country:US
Practice Address - Phone:623-521-5446
Practice Address - Fax:623-334-6724
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW -130731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z143796OtherPTAN