Healthcare Provider Details

I. General information

NPI: 1396629655
Provider Name (Legal Business Name): SUZY MASSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 STATE ST
SALEM OR
97301-5861
US

IV. Provider business mailing address

1330 MANZANITA ST NE
KEIZER OR
97303-3542
US

V. Phone/Fax

Practice location:
  • Phone: 541-900-4285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: