Doctor Name: | SUZANNE RAE STAUM |
NPI Number: | 1184932162 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MC60166575 |
Business Practice Address: | 1211 24th St Anacortes, WA - 982212562 |
Business Phone Number: | 3602991300 |
Business Fax Number: | 3602991369 |
Mailing Address: | 1211 24th St, ANACORTES |
State: | WA |
Postal Code: | 982212562 |
Phone Number: | 3602991300 |
Fax Number: | 3602991369 |
NPI Enumeration Date: | 09/23/2010 |
NPI Last Update Date: | 09/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MC60166575 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |