Basic Information
Provider Information
NPI: 1710217344
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARLIEPP
FirstName: SUZANNE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2577 NE COURTNEY DR
Address2:  
City: BEND
State: OR
PostalCode: 977017638
CountryCode: US
TelephoneNumber: 5413227500
FaxNumber: 5413227565
Practice Location
Address1: 2577 NE COURTNEY DR
Address2:  
City: BEND
State: OR
PostalCode: 977017638
CountryCode: US
TelephoneNumber: 5413227500
FaxNumber: 5413227565
Other Information
ProviderEnumerationDate: 01/04/2010
LastUpdateDate: 02/06/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  N Behavioral Health & Social Service ProvidersCounselorMental Health
1041C0700XL5027ORY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home