Provider Demographics
NPI:1871624833
Name:SCUDDER, SUZAN MARY (MA)
Entity type:Individual
Prefix:MRS
First Name:SUZAN
Middle Name:MARY
Last Name:SCUDDER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAIN ST., STE. D
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020
Mailing Address - Country:US
Mailing Address - Phone:425-778-1246
Mailing Address - Fax:425-744-5533
Practice Address - Street 1:600 MAIN ST., STE. D
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020
Practice Address - Country:US
Practice Address - Phone:425-778-1246
Practice Address - Fax:425-744-5533
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health