| Doctor Name: | SUSAN JERALD |
| NPI Number: | 1528434164 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | LH60170431 |
| Business Practice Address: | 2205 W Woodin Ave Chelan, WA - 988169310 |
| Business Phone Number: | 5093666097 |
| Business Fax Number: | 5092714471 |
| Mailing Address: | 8 W Sunrise Pr Nw, BENTON CITY |
| State: | WA |
| Postal Code: | 993208652 |
| Phone Number: | 5093666097 |
| Fax Number: | 5092714471 |
| NPI Enumeration Date: | 08/18/2015 |
| NPI Last Update Date: | 08/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LH60170431 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |