Provider Demographics
NPI:1689794802
Name:AUTH, SUZANNE RUTH
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:RUTH
Last Name:AUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543A HIGHWAY 93
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-0465
Mailing Address - Country:US
Mailing Address - Phone:208-731-7832
Mailing Address - Fax:208-734-2613
Practice Address - Street 1:3543A HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-0465
Practice Address - Country:US
Practice Address - Phone:208-731-7832
Practice Address - Fax:208-734-2613
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8070565Medicaid
ID8070485Medicaid