Individual
SUZANNE PETREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 ALLEGIANCE CIR, EVANSTON, WY 82930-3804
(307) 789-3710
(307) 789-0823
Mailing address
PO BOX 6005, EVANSTON, WY 82931-6005
(307) 789-3710
(307) 789-0823
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
424
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121776300
—
WY
Enumeration date
02/20/2007
Last updated
05/08/2014
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