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Individual

MS. SUSANNE ANNETTE SHORT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LICSW

Contact information

Practice address
17482 HIGHWAY 4, JEMEZ SPRINGS, NM 87025-8702
(612) 505-2694
Mailing address
PO BOX 573, JEMEZ SPRINGS, NM 87025-0573
(612) 505-2694

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
09928374
CO
1041C0700X
Clinical Social Worker
14543
MN
1041C0700X
Clinical Social Worker
Primary
2022-0084
NM

Other

Enumeration date
03/03/2008
Last updated
10/03/2022
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