MEDICARE: MS. SUE CARLSON SUENEELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00003624	WA

General Provider Information

NPI Number	:	1558571471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE CARLSON SUENEELL

Provider Business Mailing Address
First Line	:	619 N 35TH ST
Second Line	:	SUITE 204
City	:	SEATTLE
State	:	WA
Zip	:	98103-8642
Country	:	US
Telephone Number	:	206-285-0412
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 N 35TH ST
Second Line	:	SUITE 204
City	:	SEATTLE
State	:	WA
Zip	:	98103-8642
Country	:	US
Telephone Number	:	206-285-0412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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Directions to “ MS. SUE CARLSON SUENEELL” Practice Location

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