Active NPI
Suzanne Marie Rudolph, ED.D.
- Psychologist
- Greeley, CO
National Provider Identifier
1275575680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1815
- Practice address
- 2619 W 11TH Street Rd
Suite 23
Greeley, CO 80634-5464 - Phone
- (970) 203-0643
- Fax
- (970) 351-7165
- NPI assigned
- Jun 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1815 | CO | Primary |
Addresses
Primary practice location
2619 W 11TH Street Rd
Suite 23
Greeley, CO 80634-5464
Mailing address
2619 W 11TH Street Rd
Suite 23
Greeley, CO 80634-5464
Phone (970) 203-0643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1815 | CO | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brenda L Sharp PHD LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Loveland, CO
- NPI 1457503393
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232668800000",
"number": "1275575680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2619 W 11TH STREET RD",
"address_2": "SUITE 23",
"city": "GREELEY",
"state": "CO",
"postal_code": "806345464",
"telephone_number": "970-203-0643",
"fax_number": "970-351-7165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2619 W 11TH STREET RD",
"address_2": "SUITE 23",
"city": "GREELEY",
"state": "CO",
"postal_code": "806345464",
"telephone_number": "970-203-0643",
"fax_number": "970-351-7165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDOLPH",
"first_name": "SUZANNE",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-11",
"last_updated": "2009-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CO",
"license": "1815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greeley, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.