Provider Demographics
NPI:1871711812
Name:TESCH, SUSAN MALTZ (MS, LMFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MALTZ
Last Name:TESCH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MAIN ST
Mailing Address - Street 2:SUITE 111A
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3166
Mailing Address - Country:US
Mailing Address - Phone:425-771-9461
Mailing Address - Fax:360-692-6489
Practice Address - Street 1:406 MAIN ST
Practice Address - Street 2:SUITE 111A
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3166
Practice Address - Country:US
Practice Address - Phone:425-771-9461
Practice Address - Fax:360-692-6489
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001106106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist